The Provider Configuration Lead will focus on managing and coordinates configuration activities in Triple-S core systems for Provider Affiliation and Contract Modeler in order to compliance with requirement for Claims process as well claims payment; is responsible for accurate and timely implementation and maintenance of critical information on the claims core systems related to the healthcare provider contract ensuring adherence to business and system requirements of customers as it pertains to prior authorizations, referrals and medical policies defined and other business requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Support the Analysts actions with knowledge transfer, collaborative interactions, and common goals for the team.
Train other entry level employee in the same area.
Integrates and coordinates Configuration activities mainly to execute operational objectives assigned to the Provider Configuration Unit. May make recommendations on matters of policy and approve changes in area of expertise.
Allocates workload and resources and directly supervises personnel in order to achieve expected results.
Ensure that Provider Configuration and Contract it’s align according contract signed by the provider/facility.
Develops and monitors the implementation of plans of work for the analysis, design and implementation needed to support the corporation. In addition to ongoing operational activities, this includes special projects and corporate initiatives, among others.
Handles situations that require intervention to avoid adverse impact to the achievement of objectives. Interacts with areas inside and outside the Configuration Management Department, including external business partners.
Together with the team, meets the analysis and resolution needs of production incidents related to the configuration in a reasonable time.
Supports the identification and implementation of improvements such as PDRs, Auto Q’s, CSSBs and other mechanisms that result in process and productivity improvements.
Document enchantment to the Core System.
Provider status reports and project updates to management and stakeholders.
Participates in meetings and working groups of the core system platform user association.
Develops indicators and processes to detect, correct and prevent situations that negatively impact the company.
Any other duties as may be required from time to time by management.
REQUIRED EDUCATION, TRAINING, and/or PROFESSIONAL EXPERIENCE
Bachelor’s Degree (BD) with 3 to 5 years’ in operational area of health insurance plan, including using and configuring TSS’ core system platform. Associates Degree (60-64 credits) with 5 years’ in operational area of health insurance plan, including using and configuring TSS’ core system platform. Or at least 7 years of this experience in lieu of.
CLOSED DATE:5/23/2020
It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, gender, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.
Equality Employment Opportunity/Affirmative Action for Minorities/Females/People with Disabilities/Veterans”. Employer with E-Verify to verify the eligibility of employment of all the new employees.
We encourage Females, Veterans and Disabled to Apply
