Our growing health management organization is seeking a Configuration Manager with strong attention to detail to join our Information Systems team. Working closely with the Claims and Utilization Management teams, this position supports system business configuration documentation, development, testing, and implementation to align with company needs and priorities. Main responsibilities include hands-on configuration in production and test environments, incident tracking and resolution, release management, and project management. The successful candidate is knowledgeable in configuration of claims and billing as it relates to medical group operations, continued compliance, innovation, and company growth.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Manage configuration team workstreams to plan, lead, and execute on company-wide initiatives including scoping and resource planning.
- Schedule, organize, and prioritize work to ensure timely completion of all deliverables.
- Serve as an interdepartmental liaison between Claims, Operations, Provider Services, Utilization Management, Finance, and external clients on configuration setup and facilitate weekly meetings to maintain communication and keep projects moving forward.
- Review and revise business, provider contract, and health plan design requirements for system set-ups, configurations, and onboarding of new clients/products.
- Translate Division of Financial Responsibility (DOFR) rules, fee schedules, contract terms, and provider data into system parameters to ensure accurate claims processing.
- Manage the configuration and processing rules for capitation payments to providers, claims auto-adjudication, and authorization auto-approval processes.
- Maintain all tables and master code sets within the system to ensure compliance with health plan contracts, and regulatory changes impacting code table and claims pricing administration (e.g. ICD-10, ASC, DRG, CPT, HCPCS etc.).
- Assist in communicating issues, opportunities for improvement, and suggested enhancements regarding system function.
- Create weekly reporting for senior management regarding team performance, accomplishments, and risks. Compile information and prepare reports and analyses of results of configuration findings including appropriate recommendations.
- Develop new (and review/update existing) Policies & Procedures (P&P’s) in support of standardized and accurate configuration and maintenance.
- Remain informed on all health plan contracts and amendments as well as fee schedule and pricing changes made by health plans, CMS, and/or the State for the Medi-Cal program.
- Select staff, coach performance, and provide ongoing and timely communication regarding performance, training, and development opportunities.
- Prepare department staff’s performance reviews and conduct applicable performance reviews with staff.
- Perform other duties and special projects, as assigned.
- Will lead configuration team
- 2+ direct reports
- Will lead projects
- Bachelor’s degree in Business Administration, Healthcare Management, Computer Science, or related field required.
- Minimum of 2 years’ experience working in healthcare systems configuration and claims processing required.
- Minimum of 2 years’ management experience in a healthcare environment preferred.
- Experience working in a health plan, IPA, medical group, managed health care, Medicare, or Medi-Cal environment.
- Subject matter expertise in claims required. Billing expertise preferred.
- Systems experience with QNXT, EZ-CAP, QuickCap, preferred.
- Familiarity and understanding of healthcare management systems, healthcare code sets, benefit plans, and claims payment and pricing methodologies.
- Comprehensive knowledge of regulations and requirements regarding Medicare, Medi-Cal, DMHC, and DHCS.
- Strong problem-solving, project management, time management, and technical skills.
- Ability to establish and maintain good working relationships with staff, external clients, health plans, and government agencies, as necessary.
- Demonstrated knowledge of Microsoft Office applications (Word, Excel, PowerPoint, Access, Outlook). SQL and Microsoft Visio experience desirable.
- Excellent verbal and written communication skill. Ability to translate business requirements into non-technical terms.
- Ability to manage multiple projects and people simultaneously. Strong motivation and organizational skills.
- Demonstrated results-oriented and deadline-driven attitude. Strong attention to detail.
- Comfortable collaborating effectively and working as part of a team, as well as individually.
- Ability to use independent, ethical judgment to impart confidential information.
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
- While performing the duties of this position, the employee is regularly required to sit and use hands to finger, handle, or feel objects, tools or controls. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to walk.
- The employee must be able to lift and move up to 10 pounds. Specific vision abilities required by this position include close vision, color vision and the ability to adjust focus.
- Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.