The Manager of Provider Contract Configuration is responsible for evaluating operational processes and procedures for improvement of MetroPlusHealth Core Applications. This role will work with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to setup systems to ensure accuracy of payments processing.
Scope of Role & Responsibilities - Manage and support initiatives to focus on projects with plan wide benefit in accordance with corporate budgetary objectives
- Accountable for provider contract configuration team's accuracy and timeliness
- Oversight of team SLAs including performance management and development
- Oversight of functions performed by delegated vendor(s) as it relates to provider pricing configuration, claims processing, with emphasis on provider pricing configuration, testing and accuracy
- Manage activities and communications between key business stakeholders and Core System Vendor for implementation of new systems and optimization of current systems
- Develop and oversee SDLC methodology, including business requirements creation and sign-off, Quality Assurance, User Acceptance Testing, Production and Postproduction activities
- Address operational matters by working with business units to identify system solutions to operational issues
- Participate and advise in new business/operational initiatives
- Provide guidance on current and future system capabilities
- Identify areas of operational improvement, promote strategic relationships with business areas, vendors, governmental and partner organizations
- Collaborate with Claims Operations, Utilization Management, and Network Management to obtain business requirements for systems configuration methodologies
- Facilitate improvement of the payment transaction process by interacting with providers and various internal teams
- Manage project implementation of upgrades and new products as it relates to Core Systems.
Required Education, Training & Professional Experience - Bachelor's Degree from an accredited college or university.
- A minimum of 10 years' experience of healthcare systems such as process improvement, project management or system configuration; or
- A satisfactory equivalent combination of training, education, and experience.
- Project Management and Staff Supervision a plus
Professional Competencies - Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication
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