Sr. Manager Configuration – Healthcare

Job description

IMMEDIATE NEED for a Sr. Manager Configuration. Responsible for accurate and timely maintenance of critical provider and benefit information, including Provider fee schedules and health plan DOFR set up, in the Claims payment system. Collaborate with cross functional teams (Contracting, Network Management, Performance Management, Medical Management, Claims, DSS, Eligibility, IT) to ensure adherence to business and system requirements for system configuration as it relates to Provider data and benefit information.

 

Responsibilities:


Strategically plans, leads, and manages the overall system configuration functions for Provider data, Provider Contracts , Fee schedules, DOFR and Benefits set up.Directs the development, implementation and maintenance of provider and benefit information in the claims payment system.Supports critical business strategies by providing systematic solutions and or recommendations on business processes.Organizational expert in responding to legislative and regulatory developments and audits as it relates to provider and benefit information.Engages with IT and other departments to implement changes to business processes and systemsCreates and manages Dashboards, KPIs, SOPs, Self-Appraisal reports, Policies & Procedures to ensure and improve claims payment accuracy via accurate and effective system configurationOversees, monitors, and manages team to support all functions ensuring all organizational goals and priorities are metRetains, develops and recruits top talent to build a high performing team
 

Qualifications:


Experience in a Managed Care/IPA or other Healthcare environments a huge plus.Knowledge of HIPAA compliance issues is vital.Experience with system migration projects in terms of mapping relevant data elements required.Thorough understanding of ICD-10, CPT and HCPCS codes.Knowledge of medical terminology.Ability to interpret DOFRS, contracts and/or contract summaries.Experience with IDX preferred.Minimum 3-5 years of related experience.Proficient in Windows environment with Microsoft Office Suite, including Word, Excel, and Access, Adobe. Proficient with Microsoft Outlook or other E-mail and scheduling products.
 

Please send your resume to Marc Rodriguez, Senior Technical Recruiter for immediate consideration. Let us help you secure an interview!

 

You can also connect with Marc Rodriguez on Linkedin: https://www.linkedin.com/in/technicalrecruiter/