Director of Insurance & Claims Operations - TruHearing

About TruHearing

TruHearing is a rewarding, fun and friendly, mission-based organization that makes a real difference towards improving people’s lives. It’s not just HR saying this: employees have spoken and have voted TruHearing as one of Utah’s Top Workplaces 8 years in a row! Our employees enjoy a positive working environment in a company that has experienced rapid growth. We offer a comprehensive benefits package, educational assistance, and opportunities for advancement.

TruHearing is the market leader and a force for positive change in the hearing healthcare industry. We reconnect people to the richness of life through industry-leading hearing healthcare solutions. We work with insurance companies, hearing aid manufacturers, and healthcare providers to reduce prices and expand access to better hearing care and whole-body health.

TruHearing is part of the WS Audiology Group (WSA), a global leader in the hearing aid industry. Together with our 12,000 colleagues in 130 countries, we invite you to help unlock human potential by bringing back hearing for millions of people around the world. The WSA portfolio of technologies spans the full spectrum of hearing care, from distinct hearing brands and digital platforms to managed care, hearing centers and diagnostics locations.

About the Opportunity:

The Director of Insurance & Claims Operations is responsible for providing leadership and subject matter expertise in all insurance claims operations and revenue cycle management processes

What will you be doing?

Subject Matter Expertise and Team Management

• Lead TruHearing’s claims operations by being a subject matter expert in TruHearing’s claims submission process to payor partners and TruHearing’s adjudication of claims submitted to TruHearing for processing as a payor, with an emphasis on compliance and the revenue life cycle.
• Design TruHearing’s claims processes to satisfy third party audits by TruHearing partners.
• Provide consultative expertise to cross-functional teams on strategic priorities and will act as a company-wide resource for revenue cycle activities across commercial and government lines of business.
• Ensure adherence to Service Level Agreements and Key Performance Indicators.
• Lead and develop high-performing teams by conducting regular 1:1s to set expectations, remove obstacles, and motivate team members to deliver great work.
• Build and maintain strong relationships with internal and external stakeholders (payers, vendors).

Revenue Cycle Management and Optimization

• Set strategic direction for revenue cycle management and oversee end-to-end operations of the Insurance group.
• Implement, improve, and optimize processes, policies, and procedures based on research and analytics of the current state of operations, as well as applying subject matter expertise on best practices in the industry.

Technology and Data Analysis

• Select and manage software tools and vendors, configure systems to accomplish business objectives.
• Ensure accountability for system testing, quality control, and benefit analysis
• Utilize technology and data analytics to improve efficiency and decision-making.
• Create simple data visualization modeling, documentation of deliverables, and custom reports on performance of the insurance group functions and revenue life cycle management.

Insurance and Regulatory Compliance

• Provide a deep knowledge of various insurance types in the industry and the regulations in place per insurance type. Continue to develop that knowledge base and make sure you maintain understanding of what is current and new to the industry.
• Ensure compliance with government programs (Medicare, Medicaid) and commercial insurance requirements.
• Lead audits and risk assessments for all claims related activities for both internal teams and external partners.

What skills do you need to bring?

In addition to exhibiting the TruHearing Values of Delight, Align, Enjoy, Improve and Be Tru, this role requires the following skills and competencies.

• Subject Matter Expertise: Develops new approaches and methods in their area of expertise. Is recognized as an expert within the organization and beyond.
• Agility: Builds organizational capabilities to grow, adapt, and succeed in a rapidly changing environment.
• Analytical Thinking: Applies system-thinking perspective to large questions or concerns that have far-reaching consequences across the organization.
• Planning & Organizing: Plans and organizes at a strategic, highly impactful level.
• Strategic Thinking: Sees the big picture and how elements of strategy connect and influence one another in short and long-term scenarios, drafts and executes strategic initiatives.
• Using Technology: Teaches or coaches others how to use technology to accomplish tasks or objectives.
• Customer Focus: Ensures continued service excellence by establishing enterprise-wide solutions and methods, builds strong internal relationships.
• Managing People: Builds and manages business divisions, a manager of managers.
• Accountability: Accepts responsibility for entire departments.
• Initiative: Seizes opportunities to enhance organizational performance in the short and long-term.

What education or experience is required?

Required:

• Bachelor’s degree in business administration or related field and ten (10) years of experience in revenue cycle management, leading end-to-end transformation (process, technology, and people).
  • A combination of education and experience will be considered in lieu of a formal degree.
• Possess a comprehensive understanding of benefits verification, claims processing, claims adjudication, and revenue cycle management principles.
• Be familiar with insurance standards, CMS policy and regulations as it relates to claims processing.
• Advanced experience with Managed Medicare and/or Medicaid Claims.
• Knowledge of bundled payments, risk-sharing, and provider capitation
• Direct experience and responsibility for implementing a new claims system, including requirements definition, configuration, vendor selection, and ongoing vendor management.
• Multi-site management

Preferred:

• Master’s degree in business administration or related field.
• Start-up or early-stage high-growth company experience especially in the healthcare benefits space
• Ancillary benefits claims adjudication and revenue cycle management experience
• Experienced in execution and delivery of complex enterprise-wide initiatives, including planning, delivering, and supporting projects.
• Collaborative experience with cross-functional teams and business leaders.

What benefits are offered?

TruHearing offers a generous compensation and benefits package including health coverage, a fully vested 401k match, education assistance, fully paid long and short-term disability, paid time off and paid holidays. We are conveniently located across the street from the Draper FrontRunner station and subsidize the cost of a UTA pass with access to FrontRunner, TRAX and regular bus service – employee cost is less than $2 per day. You’ll work in an exciting and fun environment and have the opportunity to grow with us.

Work Environment

This job operates hybrid with three days in a professional office environment and two days in a professional remote office. The role routinely uses standard office equipment such as a laptop, desktop, smartphone, photocopiers, shredders, and filing cabinets. The noise level in the work environment is usually moderate. Travel for the next 2-3 years is expected to be about 30 - 50% between sites.

Equal Opportunity

TruHearing is an Equal Opportunity Employer who encourages diversity in the workplace. All qualified applicants will receive consideration for employment without regards to race, color, national origin, religion, sex, age, disability, citizenship, marital status, sexual orientation, gender identity, military or protected veteran status, or any other characteristic protected by applicable law.