DIRECTOR OF PROVIDER OPERATIONS at Apostrophe, Inc.
Apostrophe is building the health plan that can fix America.
The largest, most innovative self-insured employers have figured out how to cut 40% from their healthcare costs. Our Intelligent Health Benefits Platform makes their best practices plug-and-play for the other 80% of US employers who self-insure their health benefits. In an industry defined by complexity, opacity and indifference — Apostrophe is delivering simplicity, transparency and love.
We seek fresh ideas, new perspectives, a diversity of experiences and a dedication to delight that will help us better meet the needs of the many people and businesses that rely on us every single day. Learn more about our values.
Who You Are
You are detail-oriented, relationship-oriented and enjoy delivering high quality network solutions for your stakeholders. Individuals who will be successful in this role understand how and why network issues happen and have a strong point of view on how to prevent them given the challenges that exist in the industry. The best candidates understand that the work is highly varied and complex, and requires a high degree of discretion and independent judgment.
What You’ll Do
- Lead Network Operations, which includes provider outreach, provider disputes, unique steerage programs and support provider contracting
- Develop and implement clear and documented policies and procedures for Provider Operations
- Act as a business sponsor and owner for all provider services functions and technology systems and ensure active and proper usage of those systems
- Build and maintain all necessary network reporting including but not limited to steerage to preferred providers, provider disputes, and provider acceptance rates
- Collaborate with Claims, Finance and multiple vendors to ensure seamless provider operations to assure accurate and timely contract administration, claims and settlement processing
- Develop implementation plans and manage the implementation of all new network strategies
- Minimum of 10 years of progressively accountable leadership positions in the payer space, which includes oversight of network development, contracting and provider services/operations management
- Broad knowledge of self-funded health insurance payer practices related to provider management
- Knowledge of regulations that apply to self-funded clients
- In-depth knowledge of the principles and practices of network development and contracting, including provider reimbursement methodologies
- Strong negotiation skills, including a demonstrated ability to negotiate complex service levels and rates
- Strong knowledge of health care core administrative systems, their strategic impact and integration with other health care functions
- Strong interpersonal skills, with the ability to establish and maintain effective working relationships with diverse individuals at all levels inside and outside of Apostrophe
- Strong assessment and analytical skills, including the ability to synthesize, distill concepts, draw conclusions and identify implications
- Solid mathematical aptitude with ability to quantify impact and ROI of initiatives
- Bachelor’s Degree in Business, Health Care Administration or similar
Who We Are
Apostrophe Intelligent Health Benefits replace your current administrator and legacy provider network to deliver better benefits for less money to self-insured employers. Apostrophe is driven by simplicity, transparency and love to provide market-leading member care and put employers back in control of cost and experience.
We are a Techstars Boulder 2017 company and certified B Corporation. Blue Cross Blue Shield Kansas, Royal Street Capital and Ulu Ventures are helping us build a fast-growing, sustainable business based around our core values.
Apostrophe is a Denver tech company, but many of our clients are in the midwest and the southeast, in both mid-sized cities and rural areas, and representing traditional industries and public sector. We will spend extra effort to seek out people familiar with these areas and backgrounds.
Our home base is in the RiNo area of Denver. There is ample free parking and we are just a couple blocks from the new 38th and Blake Light Rail stop.
Apostrophe does not discriminate based on race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. We are committed to providing an inclusive and welcoming environment for all members of our staff, volunteers, subcontractors, vendors, and clients.