Essential Job Duties • Directs configuration team, and demonstrates accountability for team performance - including meeting or exceeding established performance targets; targets may be based upon specific health plan requirements, and/or federal/state requirements.
• Strategically plans, leads, and manages configuration workflow processes.
• Continuously identifies and executes opportunities for operational efficiencies and develops best practice approaches for assigned operational areas, ensuring achievement of organizational/department goals.
• Ensures appropriate resources are available to achieve department goals - escalates resource needs, rationale, and deficiencies to leadership.
• Identifies and implements strategic process improvements related to the configuration function that demonstrate return on investment (ROI).
• Establishes and maintains benefits, provider contracts, fee schedules, claims edits, and other system settings in the claim payment system.
• Directs the development and implementation of contract, benefit configuration, and fee schedules.
• Directs the implementation and maintenance of member benefits in the claims payment system and other applicable systems.
• Supports critical business strategies by providing systematic solutions and or recommendations on business processes.
• Plans for long-term success of the department and individual health plans - focusing on goals and improvements to daily operations.
• Builds and maintains strong trusted relationships with key stakeholders including health plan leadership and other cross-functi.