Sr. Manager Configuration - Remote in Orange at Prospect Medical Systems

Date Posted: 7/16/2020

Job Snapshot

Job Description



Sr. Manager Configuration

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Sr. Manager of Configuration is responsible for overseeing the accurate setup and maintenance of all Provider data, Benefit Plan code data including the DOFR configuration into the core system. This includes creation and maintenance of Provider data such as Provider demographics, Provider contracts, capitation agreements and fee schedules in the core system. This also includes set up of Benefit Plan codes along with DOFR interpretation and configuration in the core system.



Job Responsibilities/Duties

  • Manage staff. Select, hire, train and motivate staff to achieve day-to-day and long- range operational goals. Coordinate resources required to meet the business units’ objectives. Manage the resolution of problems that are escalated. Continually review and appraise the progress and performance of staff and design developmental programs tailored to meet their career goals.
     
  • Manages compliance and adheres to strict timeliness rules for completing change forms and fallout queues such as PNB, PVA/PVAS, and PFS claims. Audits vendor contracts and fee schedules to make sure the updates made by contract configuration specialists are accurate. Performs ad hoc dictionary updates as per requests from other departments. Works with IT to ensure the automatic upload of updates to dictionaries. Monitors Medicare and Medi-Cal web-sites for updates to fee schedules and regulates compliance to the IDX fee schedules. Acts as an IDX resource to the team and end- users. Trouble shoot vendor contracts based on feedback from other departments to ensure accurate adjudication of provider claims.
     
  • Review AB1455 letters for new or revised contracts
     
  • Ensures that all P & P’s are documented. Ensures that documentation is compliant for each change with regard to SOX. Implements process improvements to streamline manual processes in department.
     
  • Support the vision, values, and mission of Prospect medical Group. Be cooperative and helpful to others within the employee's own department as well as support positive interdepartmental and programmatic communications and cooperation. Provide positive feedback to other employees, both inside and outside the employee's department.



Qualifications

Minimum Education: Requires a Bachelor's degree or equivalent combination of education and experience.

Minimum Experience: Experience in a Managed Care/IPA or other Healthcare environments a huge plus. Knowledge of HIPAA compliance issues is vital. Experience with system migration projects in terms of mapping relevant data elements required. Thorough understanding of 1CD-9, CPT and HCPCS codes. Knowledge of medical terminology. Ability to read and interpret DOFRS, contracts and/or contract summaries. Knowledge of conditional logic programming a huge plus. Experience with IDX preferred. Minimum 3-5 years of related experience. Proficient in Windows environment with Microsoft Office Suite, including Word, Excel, and Access, Adobe. Proficient with Microsoft Outlook or other E-mail and scheduling products. Knowledge of basic Internet terminology and functionality.

Req. Certification/Licensure: None.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.



How to Apply

To apply for this role, or search our other openings, please visit   http://pmh.com/careers/  and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm



15031