• Sr. Manager, Systems Management

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5096
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The Senior Manager will be a key member of the department’s management team and will play a critical role in the management of the company’s core claims platform (s) and editing and pricing systems.  He/she will provide vision and direction on daily activities related to the benefits requirements used to configure the processing platforms and/or third party applications; testing and validation of the configuration and monitoring activities such as pre/post payment validation and modeling.

     

    In addition, this individual will work with various levels of management on project planning, gathering business requirements and coordinate activities related to system upgrades, system development and others corporate initiatives.  The Senior Manager of Systems Management will serve as the first level of escalation for Systems Managers and should define strategies that ensure high quality solutions and facilitate the breaking through of barriers.

     

    Responsibilities

    • Manage all functions related to the oversight of configuration, automation and analysis to ensure smooth interdepartmental operations, inclusive of cross department collaboration to define and document business requirements, pre/post implementation testing and reporting
    • Ensure requested configuration is in alignment with regulatory requirements
    • Ensure teams are meeting departmental and organizational goals
    • Provide leadership on initiative planning , development of policies / procedures
    • Identify project scope, timelines, resources, resource gaps and project risks, success measures and ensure deadlines are met
    • Troubleshoot system issues and develop solutions
    • Review and validate configuration changes and impact analysis
    • Identify enhancements to system platform and processes to gain efficiencies and ensure enhancements are implemented
    • Establish meaningful goals that align with corporate vision
    • Establish metrics for all pertinent functions that measure individual and team performance and departmental standards
    • Establish appropriate priorities and assign resources
    • Ensure managers effectively manage their work and document system changes
    • Demonstrate successful leadership in staffing, developing, motivating, training and managing a highly effective team, which includes mentoring and providing guidance to ensure continual growth of the management team down to the lowest level associate
    • Other duties as assigned

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Bachelor’s or Master’s degree in Business Administration, Information Systems, Health Care or other related fields

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Working knowledge of Managed Medicaid, Medicare claims payment methodologies in a TPA, HMO, Healthcare Exchange or hospital setting
    • QXNT Claims Platform experience is a plus
    • Ability to comprehend and interpret program requirements, provider contracts, claims payment methodologies
    • Knowledge of CPT, ICD 9/10 and HCPS coding system
    • Ability to manage multiple priorities, adapt to changing conditions and thieve in a fast pace environment
    • Proven analytical skills, project management and strategic planning with an emphasis on process improvement
    • Proficient knowledge of Microsoft Office Suite
    • Proficient experience writing TSQL or SQL queries
    • Excellent communication skills, both oral and written
    • Handles difficult situations diplomatically
    • Ability to build strong relationships within and outside the health plan

     WORK BACKGROUND/EXPERIENCE

    • Minimum of 3 years implementing or configuring health claims systems
    • 5+ years working in Healthcare or with health claim related data
    • 5+ years management experience in Information Systems, Application support or related fields; managing analytical staff
    • 5+ years gathering business requirements, managing projects and process improvements

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position.

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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