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Manager, Contract Configuration

$72k - $138k
New York, NY
On-site
Contract
1001-5000
Apply for this job
🔴 Closes on: 
Nov 22

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

  • Requisition ID: 1000001948
  • Hiring Range: $72,000-$138,000
Apply for this job
🔴 Closes on: 
Nov 22
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