Director of Provider Contract Configuration

1 week ago

New York, United States Innova Solutions Full time

An Innova Solutions Client is immediately hiring for a Director of Provider Contract Configuration

  • Position type: Full-time/Direct Hire
    Location: Manhattan, NY - Hybrid (2 days per week onsite)


Director, Healthcare Provider Configuration
Position Overview

The Director of Provider Contract Configuration is responsible for evaluating operation processes and procedures for process improvement of Healthcare Insurance Core Applications. Will work with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to setup systems to ensure accuracy of payments processing.
Job Description

  • Oversee development and implementation of short/long term business objectives
  • Direct and support initiatives to focus on projects with plan wide benefit in accordance with corporate budgetary objectives
  • Ensure provider contracts are configured timely and accurately
  • Oversee functions performed by delegated vendor(s) as it relates to benefit configuration, claims processing, provider setup and account payable system
  • Manage activities and communications between key business stakeholders and Core System Vendor for implementation of new systems and optimization of current systems
  • Develop and oversee SDLC methodology, including business requirements creation and sign-off, Quality Assurance, User Acceptance Testing, Production and Postproduction activities
  • Address operational matters by working with business units to identify system solution to operational issues
  • Participate and advise in new business/operational initiatives
  • Provide guidance on current and future system capabilities
  • Identify areas of operational improvement, promote strategic relationships with business areas, vendor, governmental and partner organizations
  • Work with provider reimbursement tools, collaborate with Claims Operations, Utilization Management, and Network Management to setup pricing methodologies
  • Facilitate improvement of the payment transaction process by interacting with providers and finance team
  • Manage project implementation of upgrades and new products as it relates to Core Systems


Minimum Qualifications

  • Bachelor's Degree from an accredited college or university.
  • A minimum of 10 years of healthcare systems experience such as process improvement, project management or system configuration.
  • Project Management and Staff Supervision a plus


Notes:

  • Familiar with HealthEdge System for claim processing (HRP-Health Rules Payer) -not a hard requirement, but a major plus.
  • HYBRID - 2 days a week in the office - Thursday is mandatory
  • Team is now being led by another manager temporarily
  • Contract team evaluates new contracts and confirms if they need to build a new configuration or use the old one
  • Comes though ServiceNow-gets assigned to an analyst
  • Goes through QA and UAT process and once approved, the contract goes into production if retroactive they will reprocess claim
  • Currently have a vendor that does 3rd party that does enrollment configurations-will be bringing this process inhouse
  • For this role, the person needs to have extensive knowledge of contracts (no from legal or contracts) on the IT side/contract configuration
  • Needs to understand claims processing
  • Different methodologies (ex: Medicare pays one way for inpatient, vs outpatient)
  • Also needs N YC experience as there are specific configurations based on NY insurance law
  • Nuances around Medicare advantage, CMS, etc???????
  • Will have analyst reporting into this position (up to 9 people-still hiring some analysts now)

PAY RANGE AND BENEFITS:
Pay Range*: $155k per year
*Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.

Benefits provided by client as this is a Direct Hire position

ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.
Website: https://www.innovasolutions.com/

Recent Recognitions:

  • Named One of America's Best Employers for New Grads by Forbes (2024
  • Named One of the Best Companies to Work For by U.S. News & World Report (Private Companies List, 2024-2025)
  • One of the Largest IT Staffing Firms in the US - Ranked #3 by Staffing Industry Analysts (SIA, 2024)
  • One of the Largest Staffing Firms in the US - Ranked #13 by Staffing Industry Analysts (SIA, 2024; includes Innova Solutions, Volt, & HireGenics)
  • Named One of the Top Ten Private Companies in Atlanta by the Atlanta Business Chronicle (2023)
  • One of the Largest Certified Minority Business Enterprises (MBEs) in the United States (NMSDC, 2024)
  • AWS Advanced Tier Services Partner with 100+ certifications


Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at or (770) 493-5588. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b.
The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.

American Cybersystems, Inc is acting as an Employment Agency in relation to this vacancy.

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