Supv Business Configuration

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Summary: 
 The Business Configuration Supervisor is accountable for verticals within the Configuration Functional Organization supporting the business configuration of the core claims adjudication platform as well as integrated ancillary platforms that support this same effort.  The Business Configuration Supervisor will lead specific verticals of the cross-functional team specializing in benefits, claims, provider, enrollment, finance. The Business Configuration Supervisor will also drive to metrics regarding HealthRules benefit setup accuracy and timeliness.

Functions:
1.       Strategy Vertical – Supervises activity and staff that define the overarching strategy to the configuration of the HealthRules platforms as well as surrounding technology that support HealthRules (i.e.: Optum, Source). This requires extensive knowledge and experience as to the hierarchy of the system rules, code sets, and validation policies and their integration & impact to ancillary applications supporting the core adjudication platform.  The Strategy function also requires the knowledge and understanding of changes made in this space and its downstream impacts to other areas and other applications/jobs/feeds outside of configuration (i.e.: portals, BizTalk, vendor file feeds, AEDW, Enrollment Database, etc.)

A.      Process Improvements – identify and define process improvements within the team as well as across the organization with our business partners (sales, claims, service, etc.)

B.      Configuration Solutions – analyze, design, determine feasibility, and prove solution concepts for mandates, BPO/Partnership implementation or introduction of new products

C.      System Releases & Environment Refreshes – understand changes and impacts an determine if new processes of configuration is required

D.      Projects & Requirements – ongoing project work will be assessed, and if feasible requirements will be developed to meet the business need

E.       Operational Analytics – retrieve, analyze, organize, report and configure data as needed to support the business

2.       Configuration Implementation Vertical

A.      Account & Benefit Configuration -  Supervises activity and staff that support the conversion, maintenance or implementation of accounts, administration of all clients medical benefits within the core adjudication system to include eligibility rules sets (i.e.:  tiers, COB, pre-ex), utilization management rules and shell benefits to accommodate proprietary vendor feeds (vision, dental, PBM, etc.).

B.      Provider Configuration – Supervises activity and staff that support the conversion and maintenance or installation of provider contracts and fee schedules

C.      Finance Configuration – Supervises activity and staff that support the creation and maintenance of billing cycles, self-funded model and creation of new billing models as developed by finance.

Primary Duties and Responsibilities:

·         Ensure that internal processes meet/exceed internal and external objectives for accuracy and turnaround time (e.g. MTM, client performance guarantees, SSAE 16, and key performance indicators).

·          In conjunction with internal business partners, review and establish processing services guidelines based on internal policy and state and federal guidelines.

·         Develop and implement strategies, policies, and goals that roll-up and align with organization’s goals.

·         Implement improved processes, best practices in configuration and management methods to generate higher ROI and workflow optimization.

·         Provide mentoring and guidance to direct reports and other associates