Summary:

Partner with business areas to identify opportunities to improve operational and service‐related processes through leveraging information technology for the contract configuration team.   Responsible for recommending system (NetworX) solutions and alternatives that meet business objectives, resolves deficiencies, ensures efficient functionality and manages process change implementations. Maintain a thorough understanding of EmblemHealth’s various processing systems including claims and provider systems to evaluate the ability of the claims team to process claims correctly according to the various contracts. Responsible for management of all configuration applications of EmblemHealth Provider Contracting pricing system.

Responsibilities:

Assess daily workflow and volumes, adjusting resources and informing Leadership, as needed, of resource or throughput deficiencies.   Track unit statistics and recommend strategies and tactics for improvement to accuracy and throughput. Responsible for leading root cause analysis efforts, identifying issues and corrective action planning.   Provide technical and analytic support and integrated solutions for NetworX. Design, implement and improve CCT department quality standards. Identify and analyze any Contracting deficiencies as it relates to NetworX across multiple contracts; recommend and facilitate solutions. Review and assign all provider contracts to the Contract Configuration Team for completion.   Measure and manage the unit’s completion of configuration assignments against inventory, release schedules and project deadlines. Monitor and track staff performance relating to contract loading maintenance and audit responses. Create, revise, review and approve Configuration related documents, including but not limited to procedure memoranda, protocols, and reports. Create and maintain weekly and monthly status and trends for Contract Configuration production, quality inventory levels; offer recommendations and submit corrective action plans for improvement and consistency. Communicate and collaborate with key business areas to effectively develop and implement business solutions; develop and manage high quality relationships with business customers. Participate with external and internal audits as well as inspection readiness. Responsible for all aspects of aging Provider Contracts and special handling requests. Supervise and coordinate the work of assigned staff.   Mentor the team and encourage a global view of the impacts of Provider Configuration on EmblemHealth business. Supervise the training of new employees and cross training of current employees. Perform other related tasks as directed, assigned, or required.

Requirements:

Bachelor’s degree required; additional experience or specialized training may be considered in lieu of educational requirements 5 – 8+ years relevant professional work experience required 2+ years’ experience in a supervisory/managerial/leadership role required Knowledge of NetworX functionality required Strong project management skills and ability to multi‐task many projects simultaneously required Excellent communication skills (verbal, written, presentation, interpersonal with all types/levels of audiences required Knowledge of medical terminology, coding protocols, provider reimbursement structures required Evidence of critical thinking and creative problem‐solving skills required Ability to develop, use, interpret and apply key business metrics required Ability to organize and lead key initiatives required Proficiency in MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required Additional Information Job Type: Standard Schedule: Full-time Employee Status: Regular Requisition ID: 1000001948 Hiring Range: $72,000-$138,000