Configuration Specialist

Glen Allen, VA 23060

Posted: 06/24/2019 Category: Other Area(s) Job Number: 28790

Title: Configuration Specialist
Location: Glen Allen, VA
Salary: $85, 000

Contact: Aaron Smith at asmith@alinestaffing.com or 586-710-7940

SUMMARY:


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.

RESPONSIBILITIES/TASKS:
  • 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.

EDUCATION:
  • 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.

EXPERIENCE:
  • 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.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Travel is required.

 

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