Operations Director

Position Summary:

Operations Director is responsible for overseeing and managing appeals process as well as the call center. They will lead a team of appeals specialists and work closely with internal and external stakeholders to ensure that all appeals are processed accurately and efficiently.

Responsibilities:

1. Guiding the development and implementation of policies and procedures related to the appeals process, including guidelines for determining the eligibility of appeals and timelines for response.
2. Managing a team of appeals specialists, CSRs including hiring, training, and performance evaluations.
3. Ensuring that appeals are reviewed and adjudicated in accordance with regulatory requirements, organizational policies, and contractual obligations.
4. Working closely with internal stakeholders, including legal, compliance, and quality assurance teams, to ensure that appeals are processed accurately and timely.
5. Analyzing appeals data and providing reports to management on trends, outcomes, and areas for improvement.
6. Leading continuous improvement efforts to streamline the appeals process, reduce costs, and improve the customer experience.
7. Collaborating with external partners, including government agencies, payers, and vendors, to resolve complex appeals and improve the appeals process.
8. Prepares and presents information and plans to senior management and the client.

Requirements

Required Skills:

1. A minimum of 5 years experience managing major complex project(s) and supporting programs and/or tasks similar to those described in the SOW.
2. Minimum of 5 years experience collaborating with cross-functional teams to fulfill program/project requirements.
3. Minimum of 5 years experience operating and/or managing a call center/telecommunications program in an AWS cloud environment.
4. Minimum 5 years experience working on a CMS contract as a Project Manager or Director.
5. Must possess a PMP and experience working in an agile environment.

Desired Skills:

Education:

Must posess a B.S/B.A. degree in a relevant discipline.

Must Possess a PMP

Good to have SAFe certification

Sparksoft is a certified Capability Maturity Model Integration (CMMI) SVC and DEV Level 3, ISO 9001:2015, ISO 27001:2013, Small Disadvantaged Business (SDB), Women-Owned Small Business (WOSB), and Small, Women-owned, Minority-owned (SWaM), and MBE/DBE/SBE consulting firm. With our focused mission "to ignite innovation, inspire transformation, and implement digital solutions for a healthier nation", we specialize in 6 specific digital health services: Test Automation, Cloud Services, DevOps Delivery, Cyber Security, Data Science, and Human-Centered Design. Since 2004, our exceptionally skilled people, proven leadership, and optimized processes all work together relentlessly to continuously push for more efficient solutions.

Sparksoft is an Affirmative Action/Equal Opportunity Employer and does not discriminate against any applicant for employment or employee because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other characteristic prohibited under Federal, State, or local laws.

In accordance with the Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors, Sparksoft Corporation is complying with the requirements that all employees assigned to a federal contract be vaccinated. Employees in need of an exemption from this policy due to a medical reason or because of a sincerely held religious belief must submit a physician's note for a medical accommodation or a religious request for accommodation to the human resources department to begin the interactive accommodation process as soon as possible. Accommodations will be granted where they do not cause Sparksoft Corporation undue hardship or pose a direct threat to the health and safety of others. New hires must show proof of vaccination.

If you need accommodation seeking employment with Sparksoft Corporation, please email [email protected] or call 410-424-7700. Accommodations are made on a case-by-case basis.

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