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Manager of Product Development and Governance

To be fully engaged in providing Quality/No Harm, Customer Experience, and Stewardship by: effectively directing and managing the Product Development and Governance department. The individual will be responsible for oversight and management of the health plan’s benefit plans throughout the product life cycle, including the product development, implementation and administration phases. Product governance involves interpretation and implementation of State and Federal mandates, State and Federal application and filing efforts, implementation of new benefits, management of the health plan’s source-of-truth benefit repository, implementation and management of CPT, HCPC and ICD-10 diagnosis code sets, and cross-functional management of benefit administration.



In addition to product responsibilities, the individual will lead the integration of State statutes and Federal regulations into operational processes and business activities that meet the needs of its internal customers and the requirements of our regulatory agencies. The individual will ensure the successful integration of regulatory requirements within operational processes by providing education, direction on process and procedure changes, guidance throughout implementation, and conducting evaluations of adherence and quality outcomes of integration initiatives.



This position has high visibility and interaction at senior levels and plays an influential role in managing the organization’s overall mission, strategy and objectives, and the individual serves as a key partner with the PMO to manage IS and operational projects within Health First Health Plans and across the Health First enterprise as they relate to benefit alignment and regulatory integration.



This position requires a blend of process knowledge, product expertise, ability to lead a team toward a common goal, aptitude for educating on complex regulatory issues, and strong analytical, communication, and leadership skills.

PRIMARY ACCOUNTABILITIES:

Recruit, develop and maintain an effective, engaged and talented staff capable of successfully supporting the integration of regulatory requirements and benefits into operational processes.
Effectively engage staff and build a high-performing team as measured by objective outcomes.
Support the growth of associates through career planning, development, supervision and counseling.
Function as the process owner for end-to-end product and benefit administration, managing product development, implementation and maintenance.
Leads the Benefits and Code Management Team, comprised of key functional business owners (Configuration, Claims, Clinical Operations, Provider Relations, Sales and Account Management, Pharmacy, Customer Service, etc.), to maximize the business results of benefits administration.
Adhere to all regulatory and certification guidelines, including HIPAA, State and Federal guidelines, and others.
Analyze the impact of new and changing laws and regulations on current business processes and educate stakeholders of those impacts.
Oversee and manage the development of appropriate policies, procedures and work flows to ensure compliance with the required regulatory legislation, OIR, and System requirements.
Optimize operational business processes, introduce innovative resolutions, and foster operational excellence across the organization as it relates to regulatory requirements and benefit alignment.
Monitor quality, compliance, and results of integration initiatives across all lines of business.
Act as liaison between the Government Programs department and the operational business areas.
Own and manage the Benefit Alignment tool, the health plan’s centralized, source-of-truth repository for product and benefit information.




Qualifications

QUALIFICATIONS REQUIRED:
A Bachelor’s Degree in health care, business administration or a related field from an accredited college/university is required. A Master’s Degree is highly-desirable.
Minimum of five years’ experience in managed care or a health insurance company
Knowledge of Medicare, Commercial and Individual coverage/guidelines in the HMO and PPO arena required
Must be considered a Subject Matter Expert of Health First Health Plans and Health First Insurance product offerings and benefits
Must possess a thorough understanding of the functional areas, operational processes and systems of Health First Health Plans.
Demonstrated ability to build, communicate and execute on a vision for strategic change.
Experience in working with regulatory issues preferred.
Exceptional interpersonal relationship skills
Demonstrates excellent written and verbal communication skills
Presents a professional image.
Experience in initiating, developing and monitoring policies, internal control procedures and operating standards.
Highly organized, motivated, responsible self-starter with excellent time management, research, analytical and problem-solving skills.
Ability to delegate responsibility
Ability to prioritize work and handle multiple projects simultaneously
Builds expert regulatory knowledge in more than one area and conveys knowledge to others.
Demonstrated proficiency in machines and software common to most offices, such as MS Word, MS Excel, MS PowerPoint, and personal computing skills.

PHYSICAL DEMANDS:
Ability to lift up to 15 pounds unassisted.
Ability to enter data using hand/wrist dexterity.
Ability to work at a computer for extended periods of time.
Ability to work extended hours as projects demand.


Job:Health First Health Plans (Health Insurance)
Organization:HF Administrative Plan Inc
Primary Location:United States-Florida - Brevard County-Rockledge
Schedule:Full-time
Shift Times:8:00 am - 5:00 pm
Job Level:Manager

Time:  Full time
Salary:  Salary
Category:  Operations

Updated: 7/27/2018 10:46:17 AM