Senior Manager, Claims - Network Operations - San Antonio, TX

Posted 20 days ago
Main Location
Minnetonka, MN, United States
Open jobs

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

The Sr. Manager, Systems Configuration is responsible for managing the overall management of system configuration with special emphasis on developing and maintaining contract, benefit and authorization set up and managing the claims inventory errors related to configuration set up through utilization of the claims system.  This position will have full oversight of all system configurations and staff assigned to the area and manages the overall strategic vision of the system configuration.  This position will rely on a number of individuals outside their direct organization to deliver services in support of the contract inventory and review process.  This includes Finance, Analytics, Credentialing, Health Care Economics, Clinical, Billing and Enrollment, Claims, Member Services and other services.  This position will operationally interact with finance, credentialing, network development, and claims personnel by maintaining, reviewing, loading electronically and accounting for all network management contracts.  This position will assist in the development and maintenance for all policies for the department.  

Primary Responsibilities:

  • Develops and implements contract, benefit and authorization configuration policies, procedures and forms and drives the overall strategic visions for system configuration
  • Participates in the development and implementation of systems that support contract and system configuration, directory production, claims payment, network development, etc.  
  • Key contributor for compliance initiatives and audits ensuring departmental processes are consistent with CMS, state, URAC, SNP and HEDIS standards and regulations
  • Oversees all claims, contract, benefit, and authorization configuration efforts and the personnel responsible for the work
  • Participates in process improvement initiatives as identified as a result of a business process review for Network Operations
  • Ensures departmental performance metrics are met and reported consistently (production, quality and TAT) on a monthly basis, and measures necessary aspects of operational management of the system configuration functionality
  • Acts as a liaison for Market Managers and/or State Directors regarding questions, contract clarification and regular updates.  Coordinates and manages monthly market meetings in coordination with the Demo/Credentialing team as needed
  • Assists and oversees the development of configuration training programs for contract configuration, benefit configuration and authorization configuration as well as the contract services staff
  • Recruits, selects and develops team members and develop direct reporting staff, utilizing available learning tools
  • Develops and administers departmental budget annually and as requested.  Manages the G&A expenditures monthly with explanations for large variances
  • Coordinates and communicates with department staff to understand and/or improve work flow.  Initiates efforts to make improvements or changes as needed
  • Maintains general working knowledge of credentialing policies and procedures to ensure successful interaction with Provider Demo/Credentialing team
  • Performs all other related duties as assigned

 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Bachelor’s degree in Business, Healthcare Administration or related field required (5 additional years of comparable work experience beyond the required years of work experience may be substituted in lieu of a bachelor’s degree)
  • 4+ years of progressively responsible systems configuration experience in a managed care environment, including 
  • 3+ years of progressive management experience
  • You will be asked to perform this role in an office setting or other company location 

Preferred Qualifications:

  • Master’s degree in Business, Healthcare Administration or related field 
  • 5+ years of management-level experience in managed care environment
  • Excellent analytical and problem solving skills with effective follow through
  • Solid verbal and written communication skills

Physical & Mental Requirements: 

  • Ability to lift up to 10 pounds
  • Ability to sit for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving


Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

 

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

 

Job Keywords: Finance, Analytics, Credentialing, Health Care Economics, Clinical, Billing and Enrollment, Claims, San Antonio, TX, Texas

Mission
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Senior Manager, Claims - Network Operations - San Antonio, TX
UnitedHealth Group