4121 Cox Rd, Suite 200 Glen Allen, VA 23060
Title: Configuration Specialist
Location: Glen Allen, VA
Salary: $85, 000
Contact: Aaron Smith at firstname.lastname@example.org or 586-710-7940
The Configuration Specialist is responsible for coordinating the development and implementation of programs and strategies to improve service to customers in the area of system configuration.
- Configures benefit system(s) with precision on both an annual and ongoing basis.
- Responsible for running claims through the system(s) in multiple real-life scenarios to ensure consistency in running and reporting claims, and to ensure compliance with both State and Federal CMS and Medicare Advantage regulations.
- Develops and improves work flows and business processes within area(s) to improve customer service, decrease operational costs, and improve overall quality.
- Identifies and/or analyzes business problems and devises procedures for solutions to the problems.
- Effectively leads projects and teams in order to produce desired results.
- Responsible for corporate communication of project results.
- Develops and implements standard policies and procedures for providing routine service.
- Assures that corporate compliance is communicated, implemented, and monitored on an ongoing basis.
- Participates in systems testing, develops procedures and controls, and provides recommendations for the ongoing improvement of the updated process.
- Assists personnel, both internally and externally, by answering questions, supplying information, and training in the area of system configuration and setup.
- Develops and maintains an effective working relationship with customers.
- Interprets and puts into production CMS changes.
- Bachelor' s degree in Business Administration, Computer Science, Information Technology, Health Care, or a related field.
- Relevant combination of education and experience may be considered in lieu of degree.
- Continuous learning, as defined by the Company' s learning philosophy, is required.
- Certification or progress toward certification is highly preferred and encouraged.
- Five years experience in claims configuration software is required.
- Supervisory and/or Analyst experience with proven experience in operational analysis, data analysis, and problem resolution type activities is preferred.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
- Ability to plan, organize, direct, and control projects.
- Excellent written and verbal communication skills.
- Ability to lead and contribute to process improvement projects.
- Working knowledge of PC applications and/or mainframe.
- Excellent analytical, organizational, and problem solving skills.
- Knowledge of Project work with the ability to meet deadlines, understand requirements, and support business deliverables.
- Ability to work successfully as both a team player and an individual contributor with little supervision.
- Ability to manage multiple priorities.
- Claims processing knowledge.
- Significant creativity to utilize system capabilities to meet benefit design.
- Ability to develop, implement, and monitor policies and procedures.
- Proficient in current industry standard PC applications and systems (e.g., Access, Excel, and Word).
- Ability to travel to business locations.
- Ability to manage vendors.
- Ability to demonstrate strong analytical skills and display the " own it" cultural belief on a daily basis.
- Knowledge of benefit/claims configuration of facets, ika, or equivalent, for claims and enrollment systems.
- Knowledge of Medicare Advantage and CMS Regulations.
- Knowledge of claims in a Medicare Advantage Organization.
- Knowledge and expertise is Configuration.
Work is performed in an office setting with no unusual hazards. Travel is required.