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Sys Configuration Manager Providers & Cntrcts

Company: Carle Health
Location: Urbana
Posted on: January 24, 2023

Job Description:

















Position Summary:




Responsible for the day-to-day operations and personnel management of the Provider and Contracts Configuration Team. Accountable for accurate and timely configuration of business rules and requirements of provider data and contract reimbursement methodologies in a large managed care organization. Plays a key role in the configuration and implementation of new markets, networks and products. Provides support to internal and external customers regarding system capabilities and/or issues. Represents the department on various strategic, planning and implementation committees.









Qualifications:




EDUCATIONAL REQUIREMENTS
None Required

CERTIFICATION & LICENSURE REQUIREMENTS
EPIC Certification Tapestry Provider Contracts Administration within 6 months.

EXPERIENCE REQUIREMENTS
Five (5) years Healthcare/Medical or Five (5) years Insurance and Two (2) years General - Supervisor General

OTHER REQUIREMENTS
Strong leadership and organizational skills are essential. Must have the ability to plan, prioritize and complete tasks under stress with frequent interruptions. Must have highly developed problem solving skills, strong analytical skills and be attentive










Essential Functions:




  • Responsible for all configuration aspects related to provider demographics, contract reimbursement, vendor records and network management.
  • Assumes responsibility for personnel related duties that include interviewing, disciplinary actions, payroll reporting, scheduling paid leave, and enforcing required rules and regulations. Monitors employee performance and ensures timely communications for the purpose of goal setting, performance evaluations, wage increases, and continued personnel actions.
  • Identifies and reports configuration gaps in systems and suggests potential system enhancements or other solutions; participates in problem solving and prioritization sessions related to business and configuration requirements; interacts with software users on efficient utilization of the system and attends user group meetings.
  • Identifies educational needs within the department and ensures appropriate training programs and materials are provided. Serves as a mentor for team members and coaches staff on improving their technical, communication, project and analysis skills.
  • Participates in a lead role on business process redesign activities for existing processes as well as implementation of new products and/or system enhancements.
  • Serves in a key role on the Tapestry Release Management team.
  • Collaborates with IT on external vendor data exchange requirements. Serves as the liaison for external trading partners and vendors including but not limited to ID Card Vendor, HRA/HSA/FSA Vendor, and Pharmacy Benefit Manager.
  • Ensures Change Control process requirements are followed and participates on the Change Control Board.
  • Provides advice and consultation to users, responds to questions and problem solves/troubleshoots.
  • Responsible for on-going use and management of multiple configuration tools developed to automate configuration. Report issues with tools, design enhancements and additional tool configurations to continually improve the accuracy and speed of configuration.









    We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. - For more information: human.resources@carle.com.



    Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted.























Keywords: Carle Health, Champaign , Sys Configuration Manager Providers & Cntrcts, Executive , Urbana, Illinois

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