Configuration Specialist Sr.
SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.
Guide and support Configuration team members, as needed. Facilitate initiatives that improve processing accuracy through configuration and provide support of the Enrollment, Billing, Authorizations, Claims, Member Services, Customer Service, Capitation, Finance and other business area processing systems in all environments by planning, development, testing and implementation of all system configuration changes, enhancements and replacements. The position functions to support operational needs and requirements. Facilitate claims processing improvement projects. Maximize the Department’s administrative and technical capabilities by leading cross-functional and process improvement projects. Accountable for ensuring that all changes are accurately tracked and recorded
- Perform software component configuration, analysis, monitoring, and performance optimization to maintain and improve the Enrollment, Billing, Authorizations, Claims, Member Services, Customer Service, Capitation, Finance and other business area processing systems.
Utilize strong analytical and troubleshooting skills to address complex issues, escalated from the department in order to identify sources of issues and work toward a resolution.
- Maintains issue tracking logs with current status and resolution. Provides regular updates on open issues to management and stakeholders.
- Working with Manager to design, develop, debug, test, maintain and improve automated processes.
- Provide guidance and support to Business and team members. Serve as a resource for the team and resolves escalated issues and tasks.
- Ensure that all system changes are accurately tracked and recorded.
- Ensure change control procedures are followed.
- Make recommendations and solve problems related to configuration and accuracy as it relates to system processing. Conduct, participate, and represent the Configuration Unit in both internal and external meetings.
- Work with business owners and Shared Services Management to develop strategic solutions, making recommendations to implement as appropriate. Act as a Subject Matter Expert for system capability, benefits, code sets, fee schedules, coding, provider contracts, workflow, authorizations, billing, enrollment and other areas related to business processing.
- Understands and considers how configuration impacts upstream and downstream applications and functionality. Coordinates with appropriate parties to ensure successful implementation for all impacted areas.
- Function as an expert in CMS, DHCS and other regulatory agency requirements and guidelines as they relate to system configuration. Articulate and transfer knowledge in informal and formal settings, including with senior leadership.
- Develop and foster a customer satisfaction focus within the department to strengthen and build relationships for both internal and external customers.
- Improve department processes by reviewing objectives and specifications, evaluating proposed changes, making recommendations, and leading projects. Make recommendations for system enhancements by providing business requirements including cases, examples, and/or test results to management for consideration.
- Implement process improvements by creating project work plans, financial estimates, and identifying time and resource requirements; by facilitating cross-functional teams; and providing timely project updates. Create test plans, including scripts, data, resources, timelines and reporting results.
- Facilitate initiatives that improve processing accuracy through configuration.
- Conduct periodic reviews or audits on configuration to ensure that compliance procedures are being followed and maintained as it relates to operational risks and business processing. Conduct overall configuration and review.
- Provide recommendations for policies and procedures and training, including flowcharts and other related material.
- Develop meaningful reports, establishing baseline performance and communicate effectiveness of system changes to the unit and management.
- Develop written policies and procedures, flowcharts and training materials in support of both the Configuration Unit and supported departments.
- Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies
- Contribute to team effort by demonstrating a strong desire to assist and share knowledge and cross training of processes, activities and configuration with the unit, effectively communicates system changes and problem resolution.
- Support other areas within Shared Services as necessary.
- Bachelor’s Degree, or equivalent experience, required.
- 5 – 7 years of configuration experience required.
- Demonstrated ability to communicate with all levels of staff.
- Excellent verbal and written communication skills.
- Excellent problem solving and organizational skills.
- Strong interpersonal skills, including ability to establish and maintain effective working relationships with others.
- Training and presentation experience.
- Experience in analysis and design of applications and databases.
- Prior claims experience and a working knowledge of claims operations.
- Specific knowledge of claims system configuration, including code sets, fee schedules, CPT, HCPCS, ICD9, ICD10, DRG, Revenue, benefit setup – PBP, BID, EOC, Milliman Tools.
- IKA Systems experience
- Two years of relevant project experience and ability to conduct project related financial analysis.
- Proficient with MS Office applications, including MS Excel, Word, Outlook, Access, PowerPoint, Microsoft project and Visio.
- Knowledge of CMS, Medical, HIPAA, DOFR, AHCCCS, Compliance, provider contracting and pricing is highly desirable.
- Knowledge of pricing and bundling tools.
- Ability to learn and quickly absorb new material.
- High motivation, initiative and ability to work independently with high level of confidence.
- Ability to work well independently and in a team environment.
- Ability to handle multiple tasks, prioritize and meet deadlines.
- Ability to appropriately maintain confidentiality.
- Ability to be flexible and adjust in a fast-paced and dynamic environment.
What’s in it for you?
- Base salary range: $71,700-$114,700 annually
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- Eleven paid holidays per year, plus 1 additional floating holiday
- Excellent 401(k) Retirement Saving Plan with employer match
- Robust employee recognition program
- Tuition reimbursement
- A work-life balance
- An opportunity to become part of a team that makes a difference to our members and our community every day!
Covid-19 Vaccination Policy
To ensure a healthy and safe work environment, if you are selected for this position, your job offer with SCAN Health will be contingent upon being fully vaccinated and providing proof of your COVID-19 vaccine within 3 days after your start date. Generally, you are considered fully vaccinated 14 days after receiving the last dose, as recommended by the manufacturer, of a vaccine that has been authorized by the FDA for use in the United States, including vaccinations that have been approved pursuant to an Emergency Use Authorization. If fully vaccinated outside of the United States, the vaccination must be listed for emergency use by the World Health Organization (WHO). If you cannot receive the vaccine because of a disability/medical reason or sincerely-held religious belief, you may request an accommodation to this requirement by contacting COVID-19 Vaccination Policy. Learn more about the COVID-19 vaccination here - https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. #LI-JR1
Job Type: Full-time
Pay: $71,700.00 - $114,700.00 per year
- Dental insurance
- Health insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
- Performance bonus
- 5 years
- Monday to Friday
Work Location: Remote