- Microsoft Word
- Microsoft Office
- Leadership Experience
- Microsoft Powerpoint
This role is a senior level technical position which requires strong analytical and problem solving skills as well as solid industry knowledge and sufficient system testing and configuration experience. He/she is responsible for the coordination and administration of configuration management activities. Manages activities performed by the team including day-to-day operations, adherence to procedures, workflow assignments and communication with internal customers. This team builds and maintains rules within the adjudication system. He/she supervises employees to include coaching, guidance and performance management.
Supervises the work of configuration analysts in the execution of their duties and responsibilities and provides training, coaching and performance management to the team
Determines staffing requirements and makes hiring and termination decisions
Work with key project stakeholders to formulate and communicate business requirements and scope of project
Work with project stakeholders to translate their requirements into specifications technical staff can understand, translate questions that technical staff has into a format the stakeholders can understand and validate their requirements
Unit tests upon development to ensure requirements have been met
Identify potential areas of automation and aid in re-engineering the underlying business processes
Responsible for coordination of production turnover of all configuration work upon user sign off
Work with business areas to understand and implement all contract configurations and benefit configurations
Develop test cases and documentation to support configuration changes/updates/additions
Set up test environment and prioritize testing
Perform root cause analysis and issue resolution (support tickets)
Execute and track test cases and documentation to support configuration changes/updates/additions and software implementations
Responsible for configuration, interface and application testing
Responsible for User Acceptance testing and implementation support
Develop and maintain standards for development of business processes and cases and their documentation
Coordinate multiple simultaneous projects and initiatives
Facilitates and leads meetings and selected workgroups.
Other duties as assigned
Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.
Bachelor’s degree, and/or years of experience and background to equate to the degree in technology, management or clinical discipline working knowledge of system development life cycle processes
One (1) to Two (2) years prior experience leading/managing staff
Experience with Medicaid, Medicare or Healthcare operational and technology
5+years of experience and background to equate to the degree in technology, management or health insurance claims discipline
3+ years of analysis experience in Healthcare Industry
Strong understanding of claim adjudication concepts
Experience in identifying solutions to resolve design issues and to effectively communicate these solutions to the project manager/supervisor
Experience in translating the results of design sessions into configuration requirements
Exceptional ability to identify and track issues and drive them to a conclusion
Experience producing project artifacts to include status reports, business requirements, non-technical design documents, etc.
Experience in user acceptance testing based on business and configuration requirements
Knowledge of principles and processes for providing customer and personal services including customer needs assessment, meeting quality standards for services and evaluation of customer satisfaction
Excellent interpersonal skills, including the ability to work across the organization and to interact, influence and negotiate effectively at all levels of management
Demonstrated ability to manage multiple priorities simultaneously in a deadline driven environment with accurate resource and time estimates
Confident team builder and leader with strong motivational skills. Adept in problem solving and resolving conflict
Strong written and verbal communication skills
Able to facilitate meetings and workgroups
Intermediate to Advanced skills in Microsoft Office (Project, Word, Excel, PowerPoint, Outlook)
Minimum Three (3) years of testing and configuration experience
Strong understanding of one or more of the following disciplines: member benefits, provider contracts, claim pricing, claims review/authorizations
Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.
Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at email@example.com.
Neighborhood is an EOE M/F/D/V and an E-Verify Employer