Manager of Provider Contract Configuration

Scope of Role & Responsibilities

• Manage and support initiatives to focus on projects with plan wide benefit in accordance with corporate budgetary objectives
• Accountable for provider contract configuration team’s accuracy and timeliness
• Oversight of team SLAs including performance management and development
• Oversight of functions performed by delegated vendor(s) as it relates to provider pricing configuration, claims processing, with emphasis on provider pricing configuration, testing and accuracy
• Manage activities and communications between key business stakeholders and Core System Vendor for implementation of new systems and optimization of current systems
• Develop and oversee SDLC methodology, including business requirements creation and sign-off, Quality Assurance, User Acceptance Testing, Production and Postproduction activities
• Address operational matters by working with business units to identify system solutions to operational issues
• Participate and advise in new business/operational initiatives
• Provide guidance on current and future system capabilities
• Identify areas of operational improvement, promote strategic relationships with business areas, vendors, governmental and partner organizations
• Collaborate with Claims Operations, Utilization Management, and Network Management to obtain business requirements for systems configuration methodologies
• Facilitate improvement of the payment transaction process by interacting with providers and various internal teams
• Manage project implementation of upgrades and new products as it relates to Core Systems.

Required Education, Training & Professional Experience

• Bachelor’s Degree from an accredited college or university
• A minimum of 10 years’ experience of healthcare systems such as process improvement, project management or system configuration; or
• A satisfactory equivalent combination of training, education, and experience
• Project Management and Staff Supervision a plus

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication