Business Systems Manager

4 weeks ago

Huntington Beach, California, United States VERDA HEALTHCARE, INC. Full time
Job Description

Verda Healthcare, Inc. is seeking a highly skilled Business Systems Manager to join our team. As a key member of our organization, you will be responsible for developing and implementing databases, data collection systems, and data analytics strategies that optimize statistical efficiency and quality.

Key Responsibilities:

  • Manage all business activities involving system development and implementation, provider, and hospital contract configuration, coding compliance, and fee schedule implementation.
  • Develop and implement databases, data collection systems, and data analytics strategies that optimize statistical efficiency and quality.
  • Responsible for accurate and timely maintenance of critical provider information on all operational and provider databases.
  • Work collaboratively across the organization to address business needs, determine configuration changes needed, and how the changes impact other areas.
  • Validate data to be housed on provider databases and ensure adherence to business and system requirements as it pertains to contracting, network management, and credentialing.
  • Audit loaded provider records for quality and financial accuracy and provide documented feedback.
  • Review current benefit and DOFR configurations and suggest improvement processes to ensure systems are working more efficiently and improve quality.
  • Troubleshoot system-related issues and analyze business needs, determine necessary configuration, and develop test scenarios to ensure accurate and complete testing.
  • Generate Provider Related reports to facilitate and support Provider Services/Provider Problem Research & Resolution.
  • Generate and distribute Network Related Compliance/Regulatory/Accreditation reports.

Requirements:

  • Bachelor's degree preferred in Computer Science, Healthcare Administration, or related field.
  • Master's Degree or equivalent preferred.
  • 3-5+ years' experience in configuration/benefits and/or medical data processing.
  • Experience with bundled payment contracting or risk and capitation required.
  • Proficient in Microsoft Suite (Excel, PowerPoint, Project, Outlook, Word, Visio, etc.).
  • Extensive experience in SQL.
  • Knowledge of medical terminology, ICD-10, CPT, and HCPCS.
  • Understand all relevant payment methodologies, including but not limited to Medicare, RBRVS, DRG, APR-DRG, OPPS, Per Diems, Capitation, and Case Rates.
  • Strong analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy.
  • Ability to manage and prioritize multiple tasks, promote teamwork, and fact-based decision making.
  • Communication skills.
  • Ability to work independently and within a team environment.
  • Familiarity of the healthcare field.
  • Critical listening and thinking skills.
  • Training/teaching skills.
  • Decision making/problem solving skills.
  • Resiliency in a changing environment.
  • Demonstrated progression of leadership and responsibility.
  • Ability to work in a fast-paced, start-up culture.
  • Proven ability to build, develop, and lead strong teams of operators.

Benefits:

  • 401(k)
  • Dental Insurance
  • Health insurance
  • Life insurance
  • Paid time off.
  • Vision insurance

Schedule:

  • 8-hour shift
  • Monday to Friday/Weekends as needed

Ability to commute/relocate:

  • Reliably commute or planning to relocate before starting work (Required)

Physical Demands:

  • Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

Other duties may be assigned in support of departmental goals.

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