The Configuration Specialist is responsible for coordinating the development and implementation of programs and strategies to improve service to customers in the area of system configuration.
Configures benefit system(s) with precision on both an annual and ongoing basis.
Responsible for running claims through the system(s) in multiple real-life scenarios to ensure consistency in running and reporting claims, and to ensure compliance with both State and Federal CMS and Medicare Advantage regulations.
Develops and improves work flows and business processes within area(s) to improve customer service, decrease operational costs, and improve overall quality.
Identifies and/or analyzes business problems and devises procedures for solutions to the problems.
Effectively leads projects and teams in order to produce desired results.
Responsible for corporate communication of project results.
Develops and implements standard policies and procedures for providing routine service.
Assures that corporate compliance is communicated, implemented, and monitored on an ongoing basis.
Participates in systems testing, develops procedures and controls, and provides recommendations for the ongoing improvement of the updated process.
Assists personnel, both internally and externally, by answering questions, supplying information, and training in the area of system configuration and setup.
Develops and maintains an effective working relationship with customers.
Interprets and puts into production CMS changes.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS:
Bachelor's degree in Business Administration, Computer Science, Information Technology, Health Care, or a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.
Five years experience in claims configuration software is required. Supervisory and/or Analyst experience with proven experience in operational analysis, data analysis, and problem resolution type activities is preferred.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Ability to plan, organize, direct, and control projects.
Excellent written and verbal communication skills.
Ability to lead and contribute to process improvement projects.
Working knowledge of PC applications and/or mainframe.
Excellent analytical, organizational, and problem solving skills.
Knowledge of Project work with the ability to meet deadlines, understand requirements, and support business deliverables.
Ability to work successfully as both a team player and an individual contributor with little supervision.
Ability to manage multiple priorities.
Claims processing knowledge.
Significant creativity to utilize system capabilities to meet benefit design.
Ability to develop, implement, and monitor policies and procedures.
Proficient in current industry standard PC applications and systems (e.g., Access, Excel, and Word).
Ability to travel to business locations.
Ability to manage vendors.
Ability to demonstrate strong analytical skills and display the "own it" cultural belief on a daily basis.
Knowledge of benefit/claims configuration of facets, ika, or equivalent, for claims and enrollment systems.
Knowledge of Medicare Advantage and CMS Regulations.
Knowledge of claims in a Medicare Advantage Organization .
Knowledge and expertise is Configuration.
Work is performed in an office setting with no unusual hazards. Travel is required.
The qualifications listed above are intended to represent the minimal skills and experience levels associated with performing the duties and responsibilities contained in this position description. The qualifications should not be viewed as absolute standards, but as general guidelines that should be considered with other position-related criteria.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.