System Configuration Lead
2 days ago
We are seeking a highly skilled and experienced System Configuration Lead to join our Clinical Operations team at Advanced Medical Management.
Job SummaryThe successful candidate will be responsible for managing and overseeing system configuration, benefits, and provider data to ensure accurate reflection of provider contracts and claims payments.
Key Responsibilities- Manage contract configuration and benefits analyst work assignment.
- Responsible for inventory, delegation, and audit for the Contract Configuration and Benefits Department.
- Plan, manage, oversee, and audit configuration of:
- Financial Responsibility by LOB: Ensure accurate financial responsibility for each line of business.
- Fee Schedules by LOB: Manage fee schedules for Medicare, Medi-Cal, and Commercial claims.
- Modifier Set Tables: Configure modifier set tables for accurate reimbursement.
- Component Unit Schemes by Scheme Name (RVUs – Facility and Non-Facility): Manage component unit schemes for facility and non-facility RVUs.
- Single Unit Schemes by Scheme Name (RVU – Anesthesia Units): Configure single unit schemes for anesthesia units.
- Anesthesia Decimal Table and Set Numbers (Related to Units and Time): Manage anesthesia decimal tables and set numbers.
- Incident Types, Subtypes, and Action Codes Cross-Department: Ensure accurate incident types, subtypes, and action codes across departments.
- Service Code Categories: Configure service code categories for accurate reimbursement.
- Plan and manage configuration of Medicare and Medi-Cal fee schedules on a monthly and quarterly basis.
- Design and implement new Standard Operating Procedures (SOPs) for the Contract Configuration and Benefits Department.
- Assist and recommend process improvements, including policies and procedures.
- Ensure accuracy of Advanced Medical Management's contract configuration through regular audits and comparisons.
- Ability to train, control, supervise, and evaluate assigned personnel.
- Serves as an escalation point for configuration issues throughout Advanced Medical Management.
- Analyze situations accurately and adopt effective courses of action.
- Ensure provider network teams are educated on new protocols and policies.
- Oversee and manage various functions of Provider Data:
- Timeliness of Onbase Claims Processing (3 Days in Queue): Ensure timely processing of Onbase claims.
- Quality Audit Performed Daily: Conduct daily quality audits.
- Timeliness of Handling Provider Add Requests: Process provider add requests in a timely manner.
- New IPA or New Area Expansion Projects: Manage new IPA or area expansion projects.
- Bachelor's degree in healthcare delivery or a related field preferred. Extensive managed healthcare experience of 10+ years in lieu of degree.
- A minimum of five (5) years of progressive supervisory or managerial/leadership experience required.
- A minimum of five (5) years 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, ICD10, RBRVS, HCPCS, HIPPS code sets.
- Must be able to develop and manage project plans, estimates, and implementations.
- Must be familiar with Microsoft Office (Word, Excel, Outlook).
- Intermediate knowledge of writing SQL queries preferred.
- Strong interpersonal skills and ability to work effectively at all levels in a collaborative team environment.
- Ability to communicate effectively both orally and in writing.
- Knowledge of equipment operation related to a variety of computer/peripheral equipment, networks, and their operation and related software applications.
- Experience with EZ-Cap configuration and operation preferred.
- Possess strong time management skills, including the ability to prioritize deadlines on multiple projects.
- Produce accurate and high-quality work on time and consistently.
- Ability to work in a fast-paced environment.
- Ability to communicate effectively both orally and in writing.
$120,000 - $150,000 per year, depending on experience.
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