Manager, Operations - Configuration

Published date Posted on Indeed on Jul 21, 2022 (20 d ago)
Manager, Operations – Configuration

Position Summary:
The Manager, Operations – Configuration will provide leadership, direction, and day to day oversight for the team responsible for configuration design, application, and supporting business operations. This role will enhance the vision and value proposition by reacting to market changes and new opportunities through the configuration function and delivery of superior auto adjudication rates. The manager partners with cross functional leadership and vendors to support departmental and enterprise level projects and initiatives of strategic importance and complexity through collaboration to understand capability needs, gather project specifications, and translate business needs into detailed requirements or enhancements. Compiles, reviews, and analyzes department production metrics, shifting resources, priorities, and processes as necessary to meet business goals and customer expectations. Will continually review policies, processes, and technology to identify areas for improvement and will provide input on strategy as business needs and direction shifts.

Position Responsibilities:

  • Management of the configuration team in the delivery of their daily job responsibilities. Monitors work queues and projects, adjusting priorities as needed to meet business needs and customer expectations.
  • Develop and maintain an integrated end-to-end workflow focused on timely and quality client implementations through thorough planning, scoping and flawless execution. Communicate potential issues/risks with delivery and develop controls and error reporting to mitigate.
  • Lead team in the development of innovate configuration designs to support unique client requests with minimal custom coding. Provide recommendations on design of new system logic to support new legislation, medical policy updates, and reimbursement methodology changes.
  • Partners with cross functional business teams and vendors to drive value, return on investment and alternative solutions that offer maximum benefits while reducing cost.
  • Leads and supports business operation activities through core system releases and interface with vendor when custom code solutions are necessary.
  • Oversees development and maintenance of policies, procedures, and training material to meet key business objectives, performance goals and regulatory requirements.
  • Leads by promoting a self-organizing agile team. Supports tracking mechanisms to ensure issues are captured, prioritized, and resolved. Conducts strategic review of issues to identify trends and implement strategies to prevent recurrence.
  • Drives high employee engagement and retention by maintaining and creating a positive working environment
  • Creates and monitors key metrics to measure health of Configuration team to share with Staff, Senior Management and Account Management as needed.
  • Maintain a timely and effective communication channel with internal business teams for significant delays and or processing issues identified during the Configuration process.
  • Ensures Configuration team is adhering to all corporate compliance policies and provides direction and support for the timely resolution of escalated and or complex issues.
  • Hires and maintains qualified staff, communicates areas of accountability and performance expectations/goals, evaluates performance and initiates correction action as necessary. Conducts performance appraisals and recommends salary adjustments.
  • Other duties and projects as assigned.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Position Qualifications:
  • Bachelor’s degree in a technical discipline, or related field of study, from an accredited college or university and
  • 7+ years leadership experience having led configuration function, knowledgeable about configuration best practices and methodologies with HealthRules, Facets, Diamond, Amisys Advance or similar payer system
  • Proven experience building and developing teams
  • Strong project management and presentation skills
  • Master’s degree
  • 7+ years’ experience in TPA or healthcare industry
  • Working knowledge and understanding of CMS policies and procedures
Skills, Knowledge and Abilities
  • Experience in plan building, provider data maintenance and reimbursement methodologies
  • Advanced problem solving, critical thinking, and process analysis skills
  • Understanding of the healthcare industry, including competitors, the regulatory environment, and industry trends. Working knowledge of health care operations such as authorizations, benefits, enrollment, provider contracting, and claims adjudication
  • Excellent written, verbal, and presentation skills to convey complex ideas, concepts, and applications.
  • Experience in data analysis, testing and implementation
  • Proficiency in Healthcare and Health Plan terminology, medical coding (e.g., CPT, HCPCS, ICD10, DRG)
  • Excellent interpersonal skills, including the ability to work collaboratively across the organization and negotiate effectively with all levels of management
  • Experience in managing projects across multiple departments or leading cross functional teams in a fast-paced work environment
  • Proficient in Microsoft Office Suite – Word, Excel, PowerPoint, Outlook, SharePoint
  • Experience with managing or working within an Agile team.
Key Competencies
  • Quality-focused, results-oriented, and possess exceptional time management skills
  • Good organizational skills, good judgment, critical thinking, and be able to multi-task in a fast paced, changing work environment
  • Integrity
  • Ethical practice and confidentiality
MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees. E-Verify is an internet-based program that compares information from an employee's Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility. MedCost does not use E-Verify to pre-screen job applicants.

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