Director of Provider Contract Configuration Specialist

4 weeks ago

New York, New York, United States MetroPlusHealth Full time
Job Summary

The Director of Provider Contract Configuration is responsible for evaluating and improving operational processes and procedures for MetroPlus Health's Core Applications. This role will work closely with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to ensure accurate payment processing.

Key Responsibilities

• Oversee the development and implementation of short- and long-term business objectives
• Direct and support initiatives to focus on projects with plan-wide benefits in accordance with corporate budgetary objectives
• Ensure provider contracts are configured timely and accurately
• Oversee functions performed by delegated vendors as it relates to benefit configuration, claims processing, provider setup, and account payable systems
• Manage activities and communications between key business stakeholders and Core System Vendors for the 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 Post-production activities
• Address operational matters by working with business units to identify system solutions 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, vendors, 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 teams
• Manage project implementation of upgrades and new products as it relates to Core Systems

Requirements

• 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

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