Summary:
- Partner with business areas to identify opportunities to improve operational and service-related processes through leveraging information technology for the contract configuration team.
- Responsible for recommending system (NetworX) solutions and alternatives that meet business objectives, resolves deficiencies, ensures efficient functionality and manages process change implementations.
- Maintain a thorough understanding of EmblemHealth's various processing systems including claims and provider systems to evaluate the ability of the claims team to process claims correctly according to the various contracts.
- Responsible for management of all configuration applications of EmblemHealth Provider Contracting pricing system.
Responsibilities:
- Assess daily workflow and volumes, adjusting resources and informing Leadership, as needed, of resource or throughput deficiencies.
- Track unit statistics and recommend strategies and tactics for improvement to accuracy and throughput.
- Responsible for leading root cause analysis efforts, identifying issues and corrective action planning.
- Provide technical and analytic support and integrated solutions for NetworX.
- Design, implement and improve CCT department quality standards.
- Identify and analyze any Contracting deficiencies as it relates to NetworX across multiple contracts; recommend and facilitate solutions.
- Review and assign all provider contracts to the Contract Configuration Team for completion.
- Measure and manage the unit's completion of configuration assignments against inventory, release schedules and project deadlines.
- Monitor and track staff performance relating to contract loading maintenance and audit responses.
- Create, revise, review and approve Configuration related documents, including but not limited to procedure memoranda, protocols, and reports.
- Create and maintain weekly and monthly status and trends for Contract Configuration production, quality inventory levels; offer recommendations and submit corrective action plans for improvement and consistency.
- Communicate and collaborate with key business areas to effectively develop and implement business solutions; develop and manage high quality relationships with business customers.
- Participate with external and internal audits as well as inspection readiness.
- Responsible for all aspects of aging Provider Contracts and special handling requests.
- Supervise and coordinate the work of assigned staff.
- Mentor the team and encourage a global view of the impacts of Provider Configuration on EmblemHealth business.
- Supervise the training of new employees and cross training of current employees.
- Perform other related tasks as directed, assigned, or required.
Requirements:
- Bachelor's degree required; additional experience or specialized training may be considered in lieu of educational requirements
- 5 - 8+ years relevant professional work experience required
- 2+ years' experience in a supervisory/managerial/leadership role required
- Knowledge of NetworX functionality required
- Strong project management skills and ability to multi-task many projects simultaneously required
- Excellent communication skills (verbal, written, presentation, interpersonal with all types/levels of audiences required
- Knowledge of medical terminology, coding protocols, provider reimbursement structures required
- Evidence of critical thinking and creative problem-solving skills required
- Ability to develop, use, interpret and apply key business metrics required
- Ability to organize and lead key initiatives required
- Proficiency in MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required
Additional Information
- Requisition ID: 1000001948
- Hiring Range: $72,000-$138,000
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EmblemHealth
Nov 02, 2024