Position Summary

The Manager of Systems Configuration is responsible for managing and oversee the systems Configuration, Benefits and Provider Data, ensuring accurate reflection of provider contracts and claims payments.

Responsibilities-duties

• Manage Contract Configuration and Benefits Analyst work assignment
• Responsible for inventory, delegation and audit for the Contract Configuration and Benefits Department
• Plan, manage, oversee and audit configuration of
• Financial Responsibility by LOB
• Fee Schedules by LOB
• Modifier Set Tables
• Component Unit Schemes by scheme name (RVUs – Facility and Non Facility)
• Single Unit Schemes by scheme name (RVU – Anesthesia Units)
• Anesthesia Decimal Table and Set numbers (Related to units and time)
• Incident Types, Subtypes and Action codes cross department
• Service Code Categories
• Plan and manage configuration of Medicare, Medi-Cal fee schedules on a monthly and quarterly basis to include all states
• Design and implement new Standard Operating Procedures (SOP) formally known as Policies and Procedures (P&Ps) Contract Configuration and Benefits Department
• Assist and recommend in the development of process improvements including policies and procedures (P&P)
• Ensures accuracy of Advanced Medical Management contract configuration through regular audits, comparisons, etc.
• Ability to train, control, supervise and evaluate the performance of assigned personnel.
• Serves as escalation point for configuration issues throughout Advanced Medical Management
• Analyze situations accurately and adopt an effective course of action
• Ensure provider network team is educated on new protocols and policies and procedures
• Oversees and manages the various functions of Provider Data:
• Timeliness of Onbase claims processing (3 days in queue)
• Quality audit is performed on a daily basis
• Timeliness of handling provider add requests
• New IPA or new area expansion projects
  
  

Education & Experience Requirements

• Bachelor’s degree in healthcare delivery or related field preferred. Extensive managed healthcare experience of 10+ years in lieu of degree.
• A minimum of five (5) years of progressive supervisory or managerial/leadership experience is required
• A minimum of five (5) years hands on experience required in an IPA/Managed Care setting primarily within the Configuration Unit
• Extensive knowledge and familiarity with operational workflows of configuration management and production management.
• Experience with system configuration and interpretation is required
• Must have experience with all lines of business, Medicare, Medi-Cal, and Commercial claims and know industry guidelines
• Must understand Medical terminology, CPT, Revenue codes, ICD10, RBRVS, HCPCS, HIPPS code sets
• Must be able to develop and manage project plans, estimates and implementations
• Must be familiar with Microsoft Office (Word, Excel, Outlook)
• Intermediate knowledge of writing SQL queries preferred
• Strong interpersonal skills and ability to work effectively at all levels in a collaborative team environment
• Ability to communicate effectively both orally and in writing
• Knowledge of equipment operation related to a variety of computer/peripheral equipment, networks and their operation and related software applications
• Experience with EZ-Cap configuration and operation preferred
• Possess strong time management skills, including the ability to prioritize deadlines on multiple projects.
• Produce accurate and high-quality work on time and consistently.
• Ability to work in a fast-paced environment
  
  

Amm Benefits

When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first:

• Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
• Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
• Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
• Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.
• Career Development: Tuition reimbursement to support your education and growth.
• Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun!