To direct and plan selection and execution of system configuration development and manage daily activities of healthcare related configuration development efforts. Define and implement policies and procedures to achieve integration of various system related configuration. Ensures the accuracy and completeness of assigned projects and programs per PHC and State of California Medi-Cal guidelines and department guidelines. Develops and executes program improvements aligned with strategic priorities... more details
Director of Configuration
Job LocationsUS-CA-Fairfield
Job ID
2024-3066
FLSA Status
Exempt
Hiring Range
$ 166,894.84 - $ 225,306.65
Overview
To direct and plan selection and execution of system configuration development and manage daily activities of healthcare related configuration development efforts. Define and implement policies and procedures to achieve integration of various system related configuration. Ensures the accuracy and completeness of assigned projects and programs per PHC and State of California Medi-Cal guidelines and department guidelines. Develops and executes program improvements aligned with strategic priorities. To provide overall project support for planning, implementation, testing, and coordination of configuration related projects. Develops, reports and presents information to all levels of PHC leadership.
Provides leadership, coaching, and coordination for assigned PHC projects and programs. Responsible for oversight of the Configuration training and audit programs.
Responsibilities
Provides daily direction to direct reports and is responsible for management, including timecards, performance discussions, mentorship, and development plans to ensure retention, development and growth of staff.
Oversees projects and monitors performance, evaluates priority level and makes changes as necessary.
Meets with direct reports to review project and program status on a routine basis, provides feedback and guidance where appropriate.
Promotes team development and works with direct reports to establish development plans.
Develops tools and standard processes to track and measure the achievement of project based goals and objectives.
Develops tools and standard processes to track and measure the achievement of the Configuration department training program.
Reviews and approves completed system changes and enhancement work plans received from the configuration staff to ensure compliance with project approval and specifications.
Ensures configuration projects are completed timely/within compliance deadlines.
Provides technical support and oversight of the Configuration training and audit programs
Reviews department policies and procedures, identifies changes for more efficient operations, drafts new policies/procedures, and communicates changes and updates to staff.
Responsible for department budget. Participates in operational meetings both on and off site as required.
Supports the Northern and Southern Region Claims Directors related to claims system configuration.
Follows and enforces Medi-Cal and PHC policies and programs, and makes recommendations for improvement. Reviews and provides direction related to State of California Medi-Cal OILs/routine Medi-Cal policy updates to implement system changes required to ensure PHC compliance with DHCS policy requirements
Reviews and provides direction related to DHCS All Plan Letters (APL) to implement system changes required to ensure PHC compliance with DHCS policy requirements
SECONDARY DUTIES AND RESPONSIBILITIES
Leads or participates in special projects and assignments as needed.
Qualifications
Education and Experience
Bachelor’s Degree in related field strongly preferred. Minimum five (5) years of experience analyzing and enhancing automated claims systems. Minimum of two (2) years of relevant project management experience, preferably in a managed care/healthcare environment. Minimum five (5) years of management experience in a configuration environment; or equivalent combination of education and experience.
Special Skills,
Licenses and
Certifications
Solid collaboration and facilitation skills required. Knowledge of AMISYS Advance or similar claim system. Understanding of claims processing, related subsystem interfaces, and how changes impact all PHC
departments. Knowledge of Microsoft Office tools. Excellent communication and documentation skills with the ability to communicate with technical and non-technical staff.
Performance
Based
Competencies
Excellent oral and written communication skills. Ability to solve complex, technical problems. Excellent interpersonal skills with ability to lead and manage staff to effectively complete assignments within established time frames and standards. Ability to effectively exercise good judgment, to handle sensitive issues with tact and diplomacy, and ability to function effectively with frequent interruptions. Ability to work on multiple projects and assignments simultaneously within established deadlines. Ability to form and lead team projects. Good organizational skills. Ability to quickly acquire in-depth knowledge of PHC systems, software, applications, processes, and managed care issues. Ability to interpret and understand technical requirements. Excellent analytical skills to troubleshoot and resolve systems problems.
Work Environment
And Physical Demands
Ability to use a computer keyboard. More than 60% of work time is spent in front of a computer monitor. Must be able to work in a fast paced environment and maintain courtesy and composure when dealing with internal or external customers. When required, ability to move, carry, or lift objects of varying size, weighing up to 10 lbs.
All HealthPlan employees are expected to:
Provide the highest possible level of service to clients;
Promote teamwork and cooperative effort among employees;
Maintain safe practices; and
Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.
HIRING RANGE:
$ 166,894.84 - $ 225,306.65
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.
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