Job Description

Posting number: 26HH912ZBKM004

Department: Hennepin Health

Division: HH Customer Service NP

Job classification: Department Administrator, Senior

Posting type: Open

Categories: Administration, Public Health, Management, Investigative, Medical Billing & Coding, Health Care Support, Program Management, Insurance, Audit

Summary

Hennepin Health is seeking a Director of Business Operations to lead core operational functions, including claims processing, member and provider services, the member walk-in service center, delegated vendor oversight, enrollment and eligibility, electronic data interchange (EDI)/data exchange, data analysis and reporting, and project management. This role also supports key strategic initiatives and ensures effective management of departmental operations.

Current Hennepin County employees who refer a candidate hired into an open competitive position may be eligible for a $500 referral bonus. For more information visit employee referral program.

Location and hours:

This position is hybrid and will be performed on-site at the Human Services Building located at 525 Portland Avenue, Minneapolis, Minnesota 55415, and remote as job duties require. Work hours will generally be Monday through Friday, between the hours of 8 a.m. – 5 p.m. While this position is designated as hybrid, based on current requirements hires must reside in or relocate to Minnesota or Wisconsin. New Employee Orientation (NEO) for all new benefit-earning employees is in-person in downtown Minneapolis. Details about NEO will be provided upon hire.

About the position type:

This is a full-time benefit earning position.

This position is internally classified as a Department Administrator, Senior.

Click here to view the job classification specification.

Note: You must attach a resume with your application materials to be considered for this position.

In this position, you will:

• Lead daily operations across claims, member and provider call centers, enrollment, EDI, and mailroom services.
• Ensure timely and accurate claim adjudication and compliant encounter data submissions.
• Oversee member and provider services with a focus on responsive and culturally informed support.
• Manage delegated vendors, performance monitoring, corrective action, and compliance oversight.
• Direct enrollment and eligibility processing, reconciliation, and compliance oversight.
• Oversee HIPAA-compliant EDI transactions (834, 837, 835, 270/271) and data quality.
• Serve as executive sponsor for major operational initiatives including implementation and optimization of healthcare technology platforms that support claims, EDI, and provider and member services.
• Lead cross-functional teams through planning, readiness, and executions of new systems and enhancements.
• Use analytics to drive workflow improvements, service quality, and operational performance.
• Closely monitor and complete ongoing reviews of customer service and claims adjudication metrics, performance, improvements, and issues, with business partners.
• Work closely with Operations Business Partners and cross-functional teams to accomplish organizational goals and meet the contractual needs as defined by the Department of Human Services (DHS) and Centers for Medicare & Medicaid Services (CMS).

Need to have:

• One of the following:
• Ten years or more of program administration experience in government or an organization closely related to government.
• Bachelor's degree or higher in business administration or other field appropriate to the position and six years or more of program administration experience in government or an organization closely related to government.

Nice to have:

• Experience:
• Working in senior operational leadership within a health plan environment.
• Supervising staff within the health care or insurance industry.
• Leading member and provider call centers.
• Preparing and managing a budget.
• Working with health insurance claims processes.
• Working in government-funded or safety net health care organizations.
• Leading large operational projects.
• Managing vendors with key performance indicators.
• Guiding cross-functional teams through significant organizational change.
• Knowledge of:
• DHS Medicaid requirements and health plan operations.
• Objectives and provisions of federal, state, and local laws/legislation and regulatory bodies pertaining to health care providers, health care delivery, managed care plans, and third-party administration.
• Principles, practices, and business methods related to managed care operations and regulations.
• Ability to:
• Manage multiple tasks and priorities in a matrixed environment.
• Demonstrate problem-solving skills.
• Plan, organize, and execute policies and programs, and apply administrative principles in organizing and directing a managed care plan.
• Prepare and review various reports, analyze complex problems, and develop effective solutions.
• Work with people at all organizational levels and initiate and promote collaborative relationships with other organizations and agencies.

About the department:

Hennepin Health provides health care coverage to Hennepin County residents who are enrolled in a Minnesota Health Care Program. Hennepin Health is a nonprofit, state-certified health maintenance organization that contracts with the Minnesota Department of Human Services. We envision being a leader in partnering with our members and communities to improve health, by integrating health care and service to enhance the health and well being of our members and the community.

About Hennepin County:

Hennepin is the largest county government organization in Minnesota. Our employees work every day to improve the health, safety and quality of life for our residents and communities. All of our jobs align with our mission to serve residents through transformative services that eliminate disparities, eliminate inequities, and create opportunity for all and our vision of a community where all people are healthy, all people are valued, and all people thrive.

Our employees receive a combination of competitive benefits and positive workplace culture not found at other organizations. This includes meaningful work that impacts our community, competitive pay, work-life balance, a variety of benefits and opportunities to grow. Learn more at The Bridge (login as Guest).

Hennepin County envisions an organization where our commitment to diversity and the elimination of disparities is fundamental in providing excellent service to our community.

Your future. Made here.

This posting may be used to fill current and future vacancies.

Watch this video for application best practices and tips.

This position will have access to systems or other documentation that contains HIPAA data.

Invitations to interview will be based upon an assessment of education and experience. Final candidates may be required to complete a criminal background check.

If you have any questions, please contact:

Brooke McNamara

Brooke.McNamara@hennepin.us