Manager - Configurations
Manager - Configurations
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Salary Not Disclosed
1 Vacancy
Job Description
Location:
Avera Health PlansWorker Type:
RegularWork Shift:
Day Shift (United States of America)Position Highlights
You Belong at Avera
Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.
A Brief Overview
The Avera Health Plan Configuration Manager oversees the configuration of the Plans claims system and related technologies to ensure efficient and accurate processing for health plan customers including our members and providers. This role will lead a team responsible to analyze plan designs and translate them into system configuration of high quality. This role also involves maintaining benefit categories networks and other configuration structures. The Manager of Configurations is responsible for the performance management of all Configurations staff. This position is responsible for planning organizing and coordinating the daily operations of the Configurations team. Timeliness and accuracy of configurations set up testing and execution to ensure compliance with Avera Health Plans policies and procedures and quality performance standards is critical in this position. Responsible for ensuring configuration management design requirements traceability and audits controls meet state and federal regulatory requirements. Develops and improves workflows and business processes within area(s) to improve customer service decrease operational costs and improve overall quality.
What you will do
- Lead and implement processes to measure and monitor the performance of the Configuration team for the purposes of education training and quality of service improvements.
- Reviews and evaluates policies and procedures of the health plan to assure they are consistently and accurately interpreted and implemented with the core system. Adhere to all applicable rules regulations and standards.
- Manage and assist with organizing configuration changes to multiple environments to reduce the potential for migration conflicts and maintain consistency.
- Ensure accurate and timely implementation and maintenance of all system configuration requests using validation and audit strategies.
- Create and implement audit protocols within the configurations department to ensure high quality and consistency of core claims processing and ensure integrity of audit protocols via the variance process to own and understand errors made and to discourage repeating such errors.
- Understand the business process activities that utilize the core system to support business requirements and initiatives and collaborate with various business units to know understand and implement strategic goals.
- Guide the configuration team providing clear communication and direction for all new and ongoing configuration projects or company initiatives.
- Understand the end to end solution design for the core claims processing software including the integrations with other platforms that interface with the software. Maintain a working knowledge of core processing software existing functionality changes and upgrades.
- Oversee the processes of new code set reviews and setup in both internal and external facing environments.
- Liaison with the software vendor(s) on matters involving the claims management system business fulfillment and claim editing.
- Responsibilities include interviewing hiring developing training and retaining employees; planning assigning and leading work; appraising performance; rewarding and coaching employees; addressing complaints and resolving problems.
Essential Qualifications
The individual must be able to work the hours specified. To perform this job successfully an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others hear understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge skills and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions as long as the accommodations do not cause undue hardship to the employer.
Required Education License/Certification or Work Experience:
- 4-6 years Health insurance experience including experience with claims systems EDI files and related technologies.
- Demonstrated ability to lead motivate and manage a team.
- Ability to analyze plan designs identify issues and propose solutions. Ability to identify and resolve configurations issues.
- Ability to effectively communicate with team members and cross-functionally with key stakeholders.
Preferred Education License/Certification or Work Experience:
- Bachelors Business Administration
Expectations and Standards
- Commitment to the daily application of Averas mission vision core values and social principles to serve patients their families and our community.
- Promote Averas values of compassion hospitality and stewardship.
- Uphold Averas standards of Communication Attitude Responsiveness and Engagement (CARE) with enthusiasm and sincerity.
- Maintain confidentiality.
- Work effectively in a team environment coordinating work flow with other team members and ensuring a productive and efficient environment.
- Comply with safety principles laws regulations and standards associated with but not limited to CMS The Joint Commission DHHS and OSHA if applicable.
Benefits You Need & Then Some
Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced healthy lives. Benefits are designed to meet needs of today and into the future.
PTO available day 1 for eligible hires.
Free health insurance options for full-time single coverage on Avera High Deductible Health Plan
Up to 5% employer matching contribution for retirement
Career development guided by hands-on training and mentorship
Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability Veteran Status or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application please call 1- or send an email to .
Required Experience:
Manager
Employment Type
Full-Time
