Manager, Configuration

1 month ago


Henderson, United States P3 Health Partners Full time

Overall Purpose:

The main functions of this position are responsible for leading, coaching and guiding staff that implement, support, and maintain the core administrative system configuration including but not limited to: EDI transactions, provider and member data, encounters, CMS/health plan, internal reporting, benefits, and data entry. This role will be responsible for continuing to enhance the vision, value proposition, services for the configuration function and develop and align the staff in place to deliver against these services.

Education:

* High school diploma or GED required + 6 years relevant work experience
* Bachelor's degree preferred

Knowledge, Skills and Abilities:

Required Skills

* Must have a strong understanding of any local, state and federal rules regarding the adjudication of medical benefits
* Strong knowledge of CPT, HCPCS, ICD-10, DRG and APC coding and CMS Guidelines.
* Strong organizational and time management skills with the ability to prioritize individual workloads.
* Proficient in MS Office with strong computer skills (e.g. multiple systems experiences, keyboarding skills, Microsoft word, Power Point)
* 5+ years of system and configuration knowledge
* Knowledge of CMS reporting: ODAG and Part C
* 5+ years encounter submission experience
* 3 to 5 years management experience.
* Extensive experience in plan building, provider data maintenance and reimbursement methodologies including fee schedules, contract management and workflow processes.
* HMO Claims, managed care and Medicare advantage experience required.

Preferred Qualifications:

* Experience analyzing and identifying trends
* Ability to interpret electronic data interchange
* Ability to drive performance management

Essential Functions:

* Coordinate and supervise daily/weekly/monthly activities of a team members including setting priorities for the team to ensure task completion and performance goals are met
* Respond configuration escalations
* Provide coaching, feedback, and annual performance reviews as well as formal corrective action
* Manage inventory and performance to business metrics
* Write and Submit P&P update requests
* Provide expertise or general system configuration support to team in reviewing, researching, investigating, system configuration
* Support team employee engagement
* Communicate and collaborate with internal and external business partners
* Document and communicate status of system configuration to stakeholders as needed
* Achieve applicable performance metrics (productivity, quality, TAT, utilization)
* Advanced problem solving, critical thinking, and process analysis skills to lead teams responsible for client configuration
* Understanding of the healthcare industry, including competitors, the regulatory environment, and industry trends
* Ability to provide strategic leadership and demonstrate the ability to develop future-state scenarios, create a vision for the future, defines factors needed to achieve success, and key actions required.
* Demonstrated leadership skills having lead configuration activity or function, knowledgeable about configuration best practices, methodologies and tools
* Other task assigned by manager



  • Henderson, United States P3 Health Partners Full time

    Overall Purpose: The main functions of this position are responsible for leading, coaching and guiding staff that implement, support, and maintain the core administrative system configuration including but not limited to: EDI transactions, provider and member data, encounters, CMS/health plan, internal reporting, benefits, and data entry. This role will be...


  • Henderson, Nevada, United States InvestorFlow Full time

    InvestorFlow is the only company of its kind to deliver industry specialized CRM, built on Salesforce, and digital portals to help alternative asset firms find opportunities, create and manage relationships, and turn relationship insights into action with increased productivity and transparency.The Associate Consultant will be an active and responsible...


  • Henderson, United States Fusion HCR Full time

    Fusion HCR is hiring! We are seeking a highly skilled Senior Network Engineer (Tier 2, Tier 3) with significant experience working with products from Palo Alto Networks. The successful candidate will be responsible for providing advanced technical support and troubleshooting expertise to ensure the optimal performance and security of our clients' network...


  • Henderson, Nevada, United States Kimco Realty Corporation Full time

    Position Title: IT Network and Infrastructure EngineerLocation: Jericho, NYFull Time/Part Time: Full timePosted Date: Posted YesterdayReq ID: R Description: The future is bright, and we're looking for smart, capable and driven people who will share our values and flourish at Kimco - North America's largest publicly traded owner and operator of open-air,...


  • Henderson, United States Ultimate Staffing Full time

    Duties Include Performs system configurations of the Workday Human Capital Management System, including core tables, eligibility rule, business processes, workflows, notifications, calculated fields, and plan setup Supports day to day operations, maintenance, and functionality of the Workday HCM system including security setup and update management...


  • Henderson, United States Ultimate Staffing Full time

    Duties Include· Performs system configurations of the Workday Human Capital Management System, including core tables, eligibility rule, business processes, workflows, notifications, calculated fields, and plan setup· Supports day to day operations, maintenance, and functionality of the Workday HCM system including security setup and update management·...


  • Henderson, United States Ultimate Staffing Full time

    Duties Include· Performs system configurations of the Workday Human Capital Management System, including core tables, eligibility rule, business processes, workflows, notifications, calculated fields, and plan setup· Supports day to day operations, maintenance, and functionality of the Workday HCM system including security setup and update management·...


  • Henderson, United States Ultimate Staffing Full time

    Duties Include· Performs system configurations of the Workday Human Capital Management System, including core tables, eligibility rule, business processes, workflows, notifications, calculated fields, and plan setup· Supports day to day operations, maintenance, and functionality of the Workday HCM system including security setup and update management·...

  • Salesforce developer

    2 months ago


    Henderson, United States Kaygen Full time

    KAYGEN is an emerging leader in providing top talent for technology based staffing services. We specialize in providing high-volume contingent staffing, direct hire staffing and project based solutions to companies worldwide ranging from startups to Fortune and Managed Service Providers (MSP) across a wide variety of industries. Job Title: Salesforce...

  • Field Engineer

    4 weeks ago


    Henderson, United States TD SYNNEX Full time

    About the RoleThe NetApp Field Engineer delivers turn-key solutions for NetApp and related vendor technologies and implements advanced services leveraging their expertise, primarily in NetApp. What You'll Do • Deliver a turnkey NetApp storage system ready for data migration or advanced software configuration• Support migration related products and...


  • Henderson, United States Hyper Networks Full time

    Job DescriptionJob DescriptionOverview  Join us in becoming a master of our customer’s goals, challenges, and problems. Our engineers agree: at Hyper Networks, you’ll take on projects and grow in ways not possible at other MSPs. Whether it’s making sure an airline has the technology to enable booking flights, a worldwide hotel chain can provide...


  • Henderson, United States Hyper Networks Full time

    Job DescriptionJob DescriptionOverview  Join us in becoming a master of our customer’s goals, challenges, and problems. Our engineers agree: at Hyper Networks, you’ll take on projects and grow in ways not possible at other MSPs. Whether it’s making sure an airline has the technology to enable booking flights, a worldwide hotel chain can provide...

  • Field Engineer

    4 weeks ago


    Henderson, United States TD SYNNEX Full time

    Job DescriptionAbout the RoleThe NetApp Field Engineer delivers turn-key solutions for NetApp and related vendor technologies and implements advanced services leveraging their expertise, primarily in NetApp. What You'll Do • Deliver a turnkey NetApp storage system ready for data migration or advanced software configuration• Support migration related...

  • Field Engineer

    3 weeks ago


    Henderson, United States TD SYNNEX Full time

    About the Role The NetApp Field Engineer delivers turn-key solutions for NetApp and related vendor technologies and implements advanced services leveraging their expertise, primarily in NetApp. What You'll Do • Deliver a turnkey NetApp storage system ready for data migration or advanced software configuration • Support migration related products and...


  • Henderson, United States Hyper Networks Full time

    Job DescriptionJob DescriptionOverview  Join us in becoming a master of our customer’s goals, challenges, and problems. Our engineers agree: at Hyper Networks, you’ll take on projects and grow in ways not possible at other MSPs. Whether it’s making sure an airline has the technology to enable booking flights, a worldwide hotel chain can provide...


  • Henderson, United States Hyper Networks Full time

    Job DescriptionJob DescriptionOverview  Join us in becoming a master of our customer’s goals, challenges, and problems. Our engineers agree: at Hyper Networks, you’ll take on projects and grow in ways not possible at other MSPs. Whether it’s making sure an airline has the technology to enable booking flights, a worldwide hotel chain can provide...


  • Henderson, United States Executive Energy Management Full time

    Job DescriptionJob DescriptionSalary: $18.00 - $20.00 per hour depending on experienceJoin our fast-growing, dynamic and SUCCESSFUL company! You will work in a fast paced andchallenging environment that constantly expands our Help Desk Technicians' skillsets.The selected candidate will be put into a Level 1 or 2 technician position and will be...


  • Henderson, United States Executive Energy Management Full time

    Job DescriptionJob DescriptionSalary: $18.00 - $20.00 per hour depending on experienceJoin our fast-growing, dynamic and SUCCESSFUL company! You will work in a fast paced andchallenging environment that constantly expands our Help Desk Technicians' skillsets.The selected candidate will be put into a Level 1 or 2 technician position and will be...

  • IT Engineer

    3 weeks ago


    Henderson, United States Thermo Systems Full time

    Career Opportunities with Thermo Systems LLC Careers At Thermo Systems LLC Current job opportunities are posted here as they become available. Subscribe to our RSS feeds to receive instant updates as new positions become available. Thermo Systems is a $100 million-dollar global, full-service control systems integration partner, providing world-class...


  • Henderson, United States Ultimate Staffing Services Full time

    Job DescriptionJob DescriptionDuties Include· Performs system configurations of the Workday Human Capital Management System, including core tables, eligibility rule, business processes, workflows, notifications, calculated fields, and plan setup· Supports day to day operations, maintenance, and functionality of the Workday HCM system including security...