Manager, Configuration

Job DescriptionJob Description:

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. What You Will Be Doing: Under general supervision, the Configuration Manager is responsible for developing and implementing department business plans, and overseeing resources and department operations in a manner that ensures timely and accurate configuration of benefit plans and provider data in HPSJ’s health information system in a manner that meets established turnaround, quality and production goals, and regulatory standards. Work is varied and moderately complex and requires a moderate degree of discretion and independent judgment. The Manager of Configuration will lead a team of multi-disciplinary resources that are responsible for the configuration and management of the QNXT core claims processing system, JIVA the medical management platform, and additional ancillary core systems for the company. The Manager of Configuration must be capable of drawing sound conclusions; interpret and follow detailed and precise written and oral instructions; prepare clear, complete and concise reports for review; supervise, evaluate, and train assigned staff; and have the ability to work well and effectively communicate with people of various professional, vocational and educational backgrounds. Supervises Configuration Analysts, Provider Data Specialists (PDM) Our Vision: Continuously improve the health of our community. Our Mission: We provide healthcare value and advance wellness through community partnerships. Essential Functions:Provide management and related abilities in support of the corporate goals and objectives.Provide leadership and management over the centralized Enterprise System Configuration team for QNXT, NetworX, CES, Optum, and JIVA employed by the Company to include the review of any technical strategies, designs, and implementations, various initiatives and ensure adherence to the short- and longer-term technical roadmap.Build, manage, and energize team members with a proven focus on delivering business results with excellent customer service. Create technical policies and procedures, and works as, or with, a Project Manager on project cost, resource estimation, tasking, and timely project completion.Provide leadership for IT in making effective and efficient use of financial resources through business and financial plans, and ability to implement standard practices in business administration, management, human resources, and GAAP.Establishes and maintains cooperative working relationships with internal and external customers to solve operational technology issues related to system configuration, technical analytics, or help desk.Ensure proper management of the team’s fiscal activities; develops budget; manages contracts; establishes and maintains procedures and systems for accurate and timely reporting on fiscal activities.Engages in team and department resource planning and work models, performs special projects and other duties as assigned.Manage documentation and test services over assigned functional areas to ensure successful change management to include but not limited to new system or application implementations; upgrades; or decommissioning.Manage a centralized core system configuration team that creates, modifies, and updates core system configuration changes in support of operational business decisions.Create and establish data driven analytics oversight of the organizations core system configuration and activities to ensure accurate and effective system operationEstablish, assist, or monitor configuration and business audits of the core system to ensure proper configuration, operational processing, security, or related business and technical needs. Ensure that core system configuration is recorded for historical purposes, integrated with the company change management, and executed in accordance with business design and requirements.Effectively communicate configuration questions, discrepancies, or issues to Management for immediate resolution.Create and establish collaborative and interactive work efforts and projects in support of business and technical configuration efforts.Develop tools and programs to support daily configuration management activities ensuring that core system operations are implemented correctly and effectively.Create, implement, or support all core system configuration management policies and procedures.Responsible for training staff on core system configuration management to include but not limited to policies, procedures, operations, and oversight.Create and maintain a centralized configuration triage process including initial intake, level one and two support, centralized management of third-party core system support tickets, and third-party defect and roadmap management. Manage and perform audits in the following areas: fee schedule updates, service code updates, category of aid, benefit management, service group management, and system synchronization for such areas.Provide technical analytics over process improvement for core systems including enhancements to auto adjudication, automatic processing, reduction in manual processing, and adoption of new core system functionality.In coordination with department and business leaders, analyze and elicit process improvement opportunities through software automation while assisting business disciplines to mature through standard operational practices.Interpret policy and procedure guidelines and analyze factual information to adapt or modify operational and technology processes in response to changing markets, regulations, or business operations.Manage and engage in analytical situations, identify or evaluate alternatives, define or implement technical or manual solutions within standard to meet the needs of the organization’s operations.Analyzes proposed changes of product or process design to determine effect on overall system; business impact; or human resources; and coordinates recording of modifications for change management control.Leverage database technologies to create data analytics and reporting in order to gather, review and prepare statistical data in such a manner as to recommend operational changes using technology. For example, compiling charts, tables or graphs to demonstrate Return on Investment (ROI) or efficiency gains. What You Bring: Knowledge, Skills, Abilities and Competencies RequiredIn-depth knowledge of regulations and procedures governing Medi-Cal and other state sponsored programs as they relate to system configuration.Strong knowledge of database concepts and terminology, including interrelationships between data fields.Strong knowledge of health information systems related to benefit plan and provider setup.Strong knowledge of contract components and language. Strong knowledge in at least four health plan functional areas, such as Authorizations, Claims, Providers, and Membership.Knowledgeable of the features, functions and configuration of all QNXT modules or other healthcare claims processing system.In-depth knowledge of and ability to plan, organize and execute complex configuration testing processes.Strong knowledge of the flow of data and information through the health plan.Financial acumen: Interprets and applies understanding of key financial indicators to make better business decisions.Strong analytical skills, including the ability to identify relevant metrics, draw conclusions and take action based on results. Manages complexity: Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.Decision quality: Makes good and timely decisions that keep the organization moving forward.Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies.Strong knowledge of and ability to identify, implement, monitor and analyze relevant metrics models, and implement effective interventions based on results.Ability to create relevant department objectives, and create, execute and monitor business plans. Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organization goals.Ensures accountability: Holds self and others accountable to meet commitments.Drives results: Consistently achieves results, even under tough circumstances.Strong oral and written communication skills with the ability to communicate professionally, effectively and persuasively to diverse individuals inside and outside of the HPSJ.Strong interpersonal skills with the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside of HPSJ.Persuades: Uses compelling arguments to gain the support and commitment of others.Collaborates: Builds partnerships and works collaboratively with others to meet shared objectives.Situational adaptability: Adapts approach and demeanor in real time to match the shifting demands of different situations.Being resilient: Rebounds from setbacks and adversity when facing difficult situations.Strong knowledge of change management theory, with the ability to implement effectively.Strong project management skills, including the ability to manage organizational-wide projects to successful conclusion. Strong customer service skills.Demonstrated ability to articulate and support HPSJ’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.Ability to supervise staff in a manner that maximizes employee performance and business results, which includes very strong coaching/counseling skills and ability to function as a mentor.Intermediate skills in Word and Excel, including the ability to including the ability to develop formulas and links.Ability to speak and be understood in English.Ability to handle confidential information with appropriate discretion. Preferred Knowledge of HPSJ systems and procedures. What You Have: Education and Experience RequiredBachelor’s Degree; andAt least eight years progressively responsible Health Plan or Payer experience; andAt least five years Medi-Cal claims experience; andManaged care experience; andAt least eight years health plan experience; andAt least five years supervisory experience; orEquivalent combination of education and experience. Licenses, Certifications Required Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability. Preferred None. What You Will Get: HPSJ Perks:Competitive salaryRobust and affordable health/dental/vision with choices in providersGenerous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution planTwo flexible spending accounts (FSAs)Employer-Paid Term Life and AD&D InsuranceEmployer-Paid Disability InsuranceEmployer-Paid Life Assistance ProgramHealth AdvocacySupplemental medical, legal, identity theft protectionAccess to exclusive discount mallEducation and training reimbursement in addition to employer-paid elective learning courses.A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.A shorter commute ­– if you’re commuting from the Central Valley to the Bay Area.Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects. We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit. HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics. Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.

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