Configuration Manager
6 days ago
Job Summary
The Configuration Manager - Benefits and Provider Data Specialist will oversee the systems configuration, benefits, and provider data ensuring accurate reflection of provider contracts and claims payments.
Responsibilities
- Manage Contract Configuration and Benefits Analyst work assignment to ensure timely and accurate completion of tasks.
- Responsible for inventory, delegation, and audit for the Contract Configuration and Benefits Department to maintain data integrity.
- Plan, manage, and oversee the configuration of financial responsibility by line of business, fee schedules by line of business, modifier set tables, component unit schemes, single unit schemes, anesthesia decimal table, incident types, subtypes, action codes, service code categories, Medicare, Medi-Cal fee schedules, and more.
- Design and implement new Standard Operating Procedures (SOPs) formerly known as Policies and Procedures (P&Ps) Contract Configuration and Benefits Department.
- Assist in developing process improvements including policies and procedures.
- Evaluate the accuracy of Advanced Medical Management contract configuration through regular audits and comparisons.
- Analyze situations accurately and adopt an effective course of action.
- Oversee and manage various functions of Provider Data: timeliness of Onbase claims processing, quality audit, handling provider add requests, IPA or new area expansion projects.
Requirements
- Bachelor's degree in healthcare delivery or related field preferred. 10+ years of managed healthcare experience in lieu of degree.
- A minimum of 5 years of progressive supervisory or managerial/leadership experience required.
- A minimum of 5 years of hands-on experience required in an IPA/Managed Care setting primarily within the Configuration Unit.
- Extensive knowledge and familiarity with operational workflows of configuration management and production management.
- Experience with system configuration and interpretation required.
- Must have experience with all lines of business, Medicare, Medi-Cal, and Commercial claims and know industry guidelines.
- Must understand medical terminology, CPT, Revenue codes, ICD-10, RBRVS, HCPCS, HIPPS code sets.
- Must be able to develop and manage project plans, estimates, and implementations.
- Familiarity with Microsoft Office (Word, Excel, Outlook) required.
- Intermediate knowledge of writing SQL queries preferred.
- Strong interpersonal skills and ability to work effectively at all levels in a collaborative team environment.
What We Offer
- Competitive estimated salary: $90,000-$120,000 per year based on location and experience.
- Opportunity to work in a dynamic and growing company.
- Collaborative and supportive team environment.
- Professional development opportunities.
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