Apply on Employer Site

tango · 7 hours ago

Director, Claims and Encounter Operations

United States

Full-time

Remote

Director/Executive

8+ years exp

Tango is a leader in the home health management industry and is preparing for significant growth. They are seeking a Director of Claims and Encounter Operations to provide strategic leadership and oversight, ensuring technical integrity and compliance of claims operations while fostering a high-performing culture.

AnalyticsHealth CareHome Health Care

H1B Sponsor Likely

Responsibilities

Ensure integrations are functioning optimally; recommend and implement enhancements to improve departmental efficiency and effectiveness

Identify, propose, and embed business rules and operational best practices that advance claims processing performance

Oversee claims vendor relationships and maintenance activities to uphold quality and compliance standards

Lead configuration and testing of plan benefits and claims within the claims system, ensuring system design aligns with business goals and compliance requirements

Serve as the business lead for process improvements and system alignment

Deliver solutions that elevate claims workflows and support organizational efficiency through cross-departmental collaboration

Oversee quality management and provide technical direction to ensure compliance with internal and external policies across all claims and encounter operations

Define, monitor, and measure operational effectiveness; analyze data to identify opportunities for improvement

Respond to and remediate operational issues in partnership with other business units and vendor partners

Collaborate with organizational leaders to achieve strategic objectives and drive organizational vision

Maintain direct accountability for all functional and technical aspects of claims processing

Foster a results-driven, compliant, and high-performing culture across the claims teams

Lead reviews and resolution efforts for auto-adjudication inhibitors, leveraging process automation and system tool advancements

Oversee technical processes for adjustments and reprocessing using automated system tools

Qualification

Healthcare claims operationsSystems configurationClaims adjudicationProcess automationOperational complianceCross-functional program managementAnalytical skillsLeadership presenceStrategic thinkingCommunication skillsProject management skillsProblem-solving

Required

Bachelor's degree required

8+ years in healthcare claims operations, including 5+ years in a leadership capacity

Deep expertise in systems configuration, claims adjudication, process automation, operational compliance, and cross-functional program management

Advanced knowledge of EDI, COB, auto-adjudication rules, and claims system platforms

Proven ability to manage complex technical implementations and drive organizational change

Strong analytical, strategic thinking, and communication skills across all organizational levels

Strategic thinker with ability to balance operational excellence with innovation

Strong leadership presence and ability to build and motivate high-performing teams

Results-oriented with proven track record of delivering measurable improvements

Detail-oriented with strong organizational and project management skills

Excellent communication and stakeholder management abilities

Self-motivated, proactive problem-solver with strong work ethic

Commitment to continuous learning and process improvement

Preferred

advanced degree preferred

Company

tango

Glassdoor3.8

tango is a post-acute management services company that provides home healthcare services.

Founded in 1987

Phoenix, Arizona, USA

201-500 employees

https://tangocare.com

H1B Sponsorship

tango has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2024 (1)

2023 (4)

2022 (1)