Manager, Systems Configuration

TITLE

Manager of Systems Configuration

POSITION SUMMARY

The Manager of Systems Configuration is responsible for managing and oversee the systems Configuration, Benefits and Provider Data, ensuring accurate reflection of provider contracts and claims payments.

RESPONSIBILITIES-DUTIES

• Manage Contract Configuration and Benefits Analyst work assignment
• Responsible for inventory, delegation and audit for the Contract Configuration and Benefits Department
• Plan, manage, oversee and audit configuration of
  1. Financial Responsibility by LOB
  2. Fee Schedules by LOB
  3. Modifier Set Tables
  4. Component Unit Schemes by scheme name (RVUs Facility and Non Facility)
  5. Single Unit Schemes by scheme name (RVU Anesthesia Units)
  6. Anesthesia Decimal Table and Set numbers (Related to units and time)
  7. Incident Types, Subtypes and Action codes cross department
  8. Service Code Categories
• Plan and manage configuration of Medicare, Medi-Cal fee schedules on a monthly and quarterly basis to include all states
• Design and implement new Standard Operating Procedures (SOP) formally known as Policies and Procedures (P&Ps) Contract Configuration and Benefits Department
• Assist and recommend in the development of process improvements including policies and procedures (P&P)
• Ensures accuracy of Advanced Medical Management contract configuration through regular audits, comparisons, etc.
• Ability to train, control, supervise and evaluate the performance of assigned personnel.
• Serves as escalation point for configuration issues throughout Advanced Medical Management
• Analyze situations accurately and adopt an effective course of action
• Ensure provider network team is educated on new protocols and policies and procedures
• Oversees and manages the various functions of Provider Data:

1. Timeliness of Onbase claims processing (3 days in queue)
2. Quality audit is performed on a daily basis
3. Timeliness of handling provider add requests
4. New IPA or new area expansion projects

EDUCATION & EXPERIENCE REQUIREMENTS

• Bachelor s degree in healthcare delivery or related field preferred. Extensive managed healthcare experience of 10+ years in lieu of degree.
• A minimum of five (5) years of progressive supervisory or managerial/leadership experience is required
• A minimum of five (5) years hands on experience required in an IPA/Managed Care setting primarily within the Configuration Unit
• Extensive knowledge and familiarity with operational workflows of configuration management and production management.
• Experience with system configuration and interpretation is required

• Must have experience with all lines of business, Medicare, Medi-Cal, and Commercial claims and know industry guidelines
• Must understand Medical terminology, CPT, Revenue codes, ICD10, RBRVS, HCPCS, HIPPS code sets
• Must be able to develop and manage project plans, estimates and implementations

• Must be familiar with Microsoft Office (Word, Excel, Outlook)
• Intermediate knowledge of writing SQL queries preferred

• Strong interpersonal skills and ability to work effectively at all levels in a collaborative team environment

• Knowledge of equipment operation related to a variety of computer/peripheral equipment, networks and their operation and related software applications
• Experience with EZ-Cap configuration and operation preferred
• Possess strong time management skills, including the ability to prioritize deadlines on multiple projects.
• Produce accurate and high-quality work on time and consistently.
• Ability to work in a fast-paced environment