Senior Manager, Business & Systems Operations
Core
Oversee system and business requirements for new and existing business to ensure performance meets health plan, state, and provider contract requirements.
Role type
Senior Manager, Business & Systems Operations
Builds
System builds for new markets and products, including configuration and testing
Domain
Health insurance / Healthcare operations
Required skills
Health care operations, system administration, product/program management, claims administration, Medicaid/Medicare coding, benefit design, reimbursement strategies, provider contract management, staff management
Preferred skills
Contracting, provider data management, Master's degree
Technologies
Claims/encounters system infrastructure, auto adjudication systems
Responsibilities
Oversee setup of system builds for new markets and products, monitor system performance trends, ensure timeliness and accuracy of reporting deliverables, establish business specifications for authorization and claims systems, implement process improvements for claims and auto adjudication, manage provider contract rate exhibits and testing
Seniority
Senior, hands-on management
