Overall PurposeThe main functions of this position are responsible for leading, coaching and guiding staff that implement, support, and maintain the core administrative system configuration including but not limited to: EDI transactions, provider, health plan benefits and member eligibility data, encounters submissions and reconciliations, CMS/health plan claim reporting, internal claim reporting and data entry. This role will be responsible for continuing to enhance the vision, value proposition, services for the configuration function and develop and align the staff in place to deliver against these services.
Essential Functions- Coordinate and supervise daily/weekly/monthly activities of a team members including setting priorities for the team to ensure task completion and performance goals are met
- Respond configuration escalations
- Provide coaching, feedback, and annual performance reviews as well as formal corrective action
- Manage inventory and performance to business metrics
- Write and Submit P&P update requests
- Provide expertise or general system configuration support to team in reviewing, researching, investigating, system configuration
- Support team employee engagement
- Communicate and collaborate with internal and external business partners
- Document and communicate status of system configuration to stakeholders as needed
- Achieve applicable performance metrics (productivity, quality, TAT, utilization)
- Advanced problem solving, critical thinking, and process analysis skills to lead teams responsible for client configuration
- Understanding of the healthcare industry, including competitors, the regulatory environment, and industry trends
- Ability to provide strategic leadership and demonstrate the ability to develop future-state scenarios, create a vision for the future, defines factors needed to achieve success, and key actions required.
- Demonstrated leadership skills having lead configuration activity or function, knowledgeable about configuration best practices, methodologies and tools
- Other tasks assigned by manager
Knowledge, Skills and Abilities- Must have a strong understanding of any local, state and federal rules regarding the adjudication of medical benefits
- Strong organizational and time management skills with the ability to prioritize individual workloads.
- Proficient in MS Office with strong computer skills (e.g. multiple systems experiences, keyboarding skills, Microsoft word, Power Point)
- Strong knowledge of CPT, HCPCS, ICD-10, DRG and APC coding and CMS Guidelines.
- Ability to drive performance management
- Ability to interpret electronic data interchange preferred
- Knowledge of CMS EDI file and submission protocols
- Knowledge of CMS claim reporting: ODAG and Part C
Experience- + 6 years health care administration operational experience
- 5 years of health care operations and health care system configuration knowledge
- Experience managing at least six direct reports
- Extensive experience in plan building, provider data maintenance and reimbursement methodologies including fee schedules, contract management and workflow processes.
- Experience analyzing and identifying trends preferred
Education- High school diploma or GED required
- Bachelor's degree preferred
Work Location & ScheduleThis role offers either a hybrid or fully remote work arrangement. Candidates within a 50-mile radius of a company office will follow our hybrid schedule, working on-site three days per week. Candidates located outside this radius will work remotely, with occasional travel to offices for meetings or key events.
Pay range: $100,000-135,000 depending on experience
