tango

Compensation

Full Description

Note: The job is a remote job and is open to candidates in USA. 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. 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 Skills • 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 • Advanced degree preferred Company Overview • tango is a post-acute management services company that provides home healthcare services. It was founded in 1987, and is headquartered in Phoenix, Arizona, USA, with a workforce of 201-500 employees. Its website is https://tangocare.com. Company H1B Sponsorship • tango has a track record of offering H1B sponsorships, with 1 in 2024, 4 in 2023, 1 in 2022. Please note that this does not guarantee sponsorship for this specific role.