Evolent Health Configuration, Manager (Healthcare) Remote in United States
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Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
We are looking for bright and energetic individuals to join the Configuration Team in Health Plan Services. If you have a penchant for detail, have prior health insurance claims processing and leadership experience, we would like to talk with you!
This position is responsible for leading staff that implement, support and maintain the core administrative system configuration for Health Plan Services Clients. This role will be responsible for continuing to enhance the vision, value proposition, services for the configuration function and develop and align the staff in place to deliver against these services. Additionally, this role will work in concert with department leadership and Operations Teams to deliver strategic objectives, and initiatives. This role will report to the Director of Configuration.
What You’ll Be Doing:
Oversee development of configuration builds, including benefit and payment rules, provider reimbursement and structures, and system parameters that accurately process and pay claims as specified in client contracts.
Provide recommendations on development and design of new system logic to support legislative activity, medical policy changes, and reimbursement methodology changes.
Be an active participant in quality assurance activities to promote traceability, accountability and adherence to standards and best practices for configuration in a multi-instance model within production teams.
Coordinate identification, prioritization and resolution of issues with various business areas and vendors that impact production and quality.
Develop tactical plans to improve processes and systems.
Assist in completing projects related to increased efficiencies, productivity, and quality for the Configuration function.
Act as a contributor to establish and meet short and long-term department goals consistent with company objectives and division strategy.
Work with department leadership and human resources to evaluate role definition, levels, and career paths.
Recruit and hire top talent
Evaluate and align staff against target operating model, roles, and career paths.
Provide clear and consistent expectations to support management and staff around roles and levels to better assess employee placements and inform career path progression.
Expand employees' abilities by mentoring, coaching and developing top talent. Coordinate the training and development of direct staff including the competency assessment process. Act as the mentor and champion of training and career development processes for assigned staff.
Lead the team on development of new methods and tools to advance efficiency and standards for maintenance of configuration. Utilizes personal subject matter expertise to produce innovative solutions for clients and the enterprise.
Foster a trusting and safe environment with an emphasis on problem solving and continuous improvement
Model servant leadership: protect the team, inspire the team, take an active role in setting the team up for success
The Experience You’ll Need (Required):
Associate or Bachelor’s degree preferred.
Extensive experience in health insurance claims processing and system configuration with a minimum of 3 to 5 years management experience.
Extensive experience in plan building, provider data maintenance and reimbursement methodologies including fee schedules, contract management and workflow processes.
HMO Claims, managed care and Medicaid experience required.
In-depth knowledge of medical billing and coding
Strong leadership and management skills
Excellent interpersonal, oral and written communication skills
Strong attention to detail and organization
Ability to work independently; strong analytic skills
Advanced skill level of Microsoft Office Suite (Excel, Word, Power Point)
Advanced problem solving, critical thinking, and process analysis skills to lead teams responsible for client configuration
Understanding of the healthcare industry, including competitors, the regulatory environment, and industry trends
Ability to provide strategic leadership and demonstrate the ability to develop future-state scenarios, create a vision for the future, defines factors needed to achieve success, and key actions required.
Demonstrated leadership skills having lead configuration activity or function, knowledgeable about configuration best practices, methodologies and tools
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.
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