Supervisor, Benefits Configuration - Full Time, Days at Prospect Medical Systems - CA in Orange, California

Job Description:

Supervisor, Benefits Configuration - Full Time, Days

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Supervisor of Benefits Configuration has oversight of the Benefits Configuration Team. Areas of responsibility may also include staffing, coaching, performance management, system configuration and auditing. Incumbent also interprets and configures the financial risk matrix (DOFR) for each health plan into the IDX system. The individual will also be a lead role for various projects to assess future business goals and objectives to assess the core systems ability to meet those needs

Job Responsibilities/Duties

• Supervise staff. Select, hire, train and motivate staff to achieve day-to-day and long- range operational goals. Coordinate resources required to meet the business units' objectives. Manage the resolution of escalated issues. Continually review and appraise the progress and performance of staff and design developmental programs tailored to meet their career goals.
• Ability to assist team with benefits configuration and issue resolution as needed.
• Financial risk matrix (DOFR) configuration and maintenance. Configures all aspects of financial risk per health plan utilizing the Financial Risk Matrix for major commercial, Medicare Advantage and Medicaid Health Plans. Create and maintain configuration templates when loading benefit information. Establish and monitor QA process for benefit builds.
• Documentation creation and maintenance. Maintain documentation in the form of Policies and Procedures, Job Aids, build documents and others. Maintain IDX dictionaries for CPT, HCPCS and ICD-10 updates. Performs ad hoc dictionary updates as per requests from other departments. Acts as an IDX resource to the team and end-users.
• Assist in the research and resolution of benefit and financial risk inquires submitted by business partners within established time frames.
• Ensure health plan configuration within system templates, related plans and benefits are updated as needed as well as tested and audited if issues are found in Benefit Configuration.
• Report creation, maintenance, and oversight. Assist with creation of new reports and existing reports(s) maintenance as needed. Analyzes root cause of errors; communicates errors to the appropriate business partners and escalates configuration errors, issues, or problems to the Business Unit Director. Assists in the research and evaluation of additional system capabilities required to support business needs.

Minimum Education: The position requires a bachelor's degree or equivalent combination of education and experience required.

Minimum Experience: Excellent written and verbal communication skills. Strong project management skills as well as the ability to manage multiple complex projects simultaneously. Strong strategic and analytical skills. Experience in a Managed Care/IPA or other Healthcare environments a huge plus. Knowledge of HIPAA compliance issues are vital. Thorough understanding of ICD-10, CPT and HCPCS codes. Knowledge of medical terminology. Knowledge of conditional logic programming a huge plus. Experience with IDX preferred. Minimum three to five (3-5) years of related experience preferred. Proficient in Windows environment with Microsoft Office Suite, including Word, Excel, and Access, Adobe. Proficient with Microsoft Outlook or other E-mail and scheduling products. Knowledge of basic Internet terminology and functionality.

Req. Certification/Licensure: None.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

• Company 401K
• Medical, dental, vision insurance
• Paid time-off
• Life insurance

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www.eeoc.gov/