tango

Compensation

Full Description

tango is a leader in the home health management industry and is preparing for significant growth! Our mission is to deliver innovative, home-based, post-acute solutions through proprietary technology and proven processes. We partner with health plans to provide a comprehensive suite of products and services designed to manage the total cost of care. We are currently looking for a Director, Claims and Encounter Operations to join our growing team! Position Description: Provides strategic leadership and oversight to claims and encounter operations, driving process innovation, system optimization, regulatory compliance, and cross-functional program delivery. This role is accountable for ensuring technical integrity, efficiency, and compliance of all claims and encounter operations while fostering a high-performing, results-driven culture. Office Location: • * Remote ** Responsibilities include, but are not limited to the following: • 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. Qualifications: • Bachelor's degree required (advanced degree preferred) • 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 Proven Personal Attributes: • 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 tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.