HealthRules Payer Sr. Project Manager- Health Insurance

Responsibilities

• Uses program and project management experience, training, and skills to run successful projects within a Health Insurance Organization, specifically a HealthRules Payer claims system Implementation/Migration.
• Engages with multiple stakeholders at all levels of the organization, including executives, directors, managers, and individual contributors.
• Coordinates the global design with the vendor to ensure that business needs are viewed in whole rather than at a functional level only.
• Coordinates crossfunctional UAT and E2E testing needs and ensures that the end-toend business processes are tested appropriately.
• Provides configuration expertise for HealthRules Payer, and on-the-job guidance and training for other project staff.
• Owns and manages the program Functional teams, ensuring that overall business needs are addressed as related to the scope.
• Ensures deliverables are on track and escalates any project-related issues.
• Participates in the Change Control process within the Functional Domain.
• Develops and manages a project schedule throughout the project life cycle, from initiation through postimplementation.
• Applies formal Change Management processes when substantive modifications affecting the project scope, timeline, or resources/budget are suggested or necessary.
• Facilitates and/or leads process improvement discussions and ensures that current state, desired state, and gaps are well-documented for the development of recommendations.
• Facilitates issue resolution through analysis and collaboration; develops and presents recommendations to leadership and negotiates to reach a resolution.
• Supports postimplementation stabilization and project closure activities.

Requirements

• Must have hand-on experience in the HealthRules Payer claims system and understand the configuration of that system.
• Prior experience with a HealthRules Payer and GuidingCare Implementation or conversion required.
• Proven success in multiple project implementations within a health insurance company in claims, billing, provider, enrollment, benefits, and medical management (GuidingCare), etc.
• Demonstrated strong expertise in HealthRules Payer configuration, while providing hand-on guidance and training to project team members.
• Able to understand and impartially consider project needs among diverse colleagues in various departments of the same organization.
• Able to produce accurate and precise work, detect and resolve discrepancies all while meeting deadlines.
• History of exemplary relationship management and effective communication with project sponsor, leaders, and team members from across the healthcare organization.
• Proficiency with MS Office Suite (Outlook, Word, Excel, PowerPoint), MS Project, and Visio required.
• Proficiency with SharePoint, Access, and SQL preferred.
• Familiarity with various project methodologies (Waterfall, Agile, SaFe, Hybrid).

Qualifications

• Bachelor’s degree in healthcare administration or related field.
• Four (4) years of experience managing projects within a health care organization may be considered in lieu of a bachelor’s degree.
• Hand-on experience with HealthRules Payer across key functional areas, including enrollment, claims, billing, finance, provider management, medical management, and benefits.
• At least five (5) years of experience working within a medical health care (insurance) organization.
• Three (3) years of experience managing one or more phases of a small to medium-sized project involving a minimum of five (5) cross-functional team members in a matrixed health care organization or closely related industry.
• PMP, PgMP, Scrum Master, Six Sigma Belt certification preferred.