Manager, Contract Configuration
: Job Details :

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: 100#######
• Hiring Range: $72,000-$138,000