Supervisor, Provider and Contract Configuration - Full Time, Days (PMS - Remote) at Prospect Medical Systems - CA in Los Angeles, California

Job Description:

Supervisor, Provider and Contract Configuration - Full Time, Days (PMS - Remote)

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 Provider and Contracts Configuration has oversight of the Provider Configuration Team. Areas of responsibilities include staffing, coaching, performance supervision, system configuration, auditing, and training. Incumbent is responsible for provider contract configuration, capitation and maintenance of Medicare, Medi-Cal, and Medi-Caid fee schedules in the core claims payment system(s). Individual is also responsible for implementing any new MSO/IPAs to ensure accurate claims processing. The individual will also be a lead for various projects to assess future business goals and objectives to assess the core systems ability to meet those system 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. Supervise and own 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.
• Work closely with Senior Executives and staff to assess and respond to escalated configuration needs.
• Facilitate and mange the supervise the resolution of escalated configuration issues, including liaise between process and technical disputes.
• Act as Point of Contact for team and business partners to discuss process improvement opportunities. Accountable for ownership and resolution of these opportunities.
• Collaborate with Product Owners to ensure that Provider/Contract Configuration solutions and deliverables are met as agreed.
• Maintains excellent, proactive, and transparent communication with leaders, stakeholders, including IT and other business partners to ensure deliverables are met.
• Ensures SDLC adherence, change management compliance, and establishes system and configuration standards that are necessary to support Prospect Medical Systems' business requirements.
• Partners with Director and Executive leaders to integrate business needs into the development of Portfolios, roadmaps, back logs, prioritization, requirements, and performance (SLA) Metrics.
• Supervises and implements Provider/Contract Configuration operational and configuration approach that improves team quality metrics and velocity, such as implementation of defined projects/requirements, conditions of acceptance, Quality Audit (QA) best practices, UAT and Stakeholder accountability.
• Implement and utilize Agile and Scrum project and operation processes across all team members, partners, and stakeholders.
• Ability to assist team with benefits configuration and issue resolution as needed.
• Supervise teams' Provider related "alerts" and workload, including various claims queues, while monitoring, and maintaining established SLAs.
• Ensure all changes related to new, amended and terminated provider contracts are applied to provider dictionaries, vendor contracts, fee schedules and capitation agreements timely and accurately.
• Partner with Claims and IT for testing as needed
• Ensure referral rules are updated in various systems for all networks and specialties.
• Assist team and Auditors with Medicare and Medical Fee schedule implementation and monitor changes
• Analyzes root cause of errors; communicates errors to the appropriate business partners and escalates configuration errors, issues, and/or problems to the Business Unit Director
• Assist team with research and evaluation of system capabilities required in support of business partner and/or provider business needs.
• Perform as a Configuration systems resource to the team and end users.
• Report creation, maintenance, and oversight. Assist with creation of new reports and existing reports(s) maintenance as needed.

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 supervise 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 preferred. Thorough understanding of ICD-10, CPT and HCPCS codes preferred. Knowledge of medical terminology preferred. Above average knowledge and understanding of provider contracts and interpretation and translation into systematic configuration terms preferred. 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/