Description and Requirements
The Claims and Provider Payment Modernization Manager represents Healthfirst Operations in the support of defined claims-related and/or provider payment modernization efforts. S/he will have business oversight of capabilities as they transition from legacy models and systems into new standard configurations and new systems. This role carries strategic importance and will help generate new operational processes and operating models. The role requires a strong understanding of program and project management best practices, including timeliness, issue resolution, risk mitigation, communications, and stakeholder management.
Duties & Responsibilities:
- Manages assigned initiatives, including workplan development, stakeholder management, change management, implementation, success measurement, and communication of project status to business stakeholders.
- Partners with IT and Delivery teams in the delivery of technical components within existing frameworks and methodologies required by Healthfirst.
- Works across multiple departments in the development of business requirements and associated artifacts by developing a deep understanding of business needs, and by collaborating closely with peers, leaders, and staff throughout Operations to ensure the appropriate parties are contributing.
- Works with team members to develop comprehensive process improvement and implementation plans, assisting with operational readiness efforts to ensure seamless transition from legacy to new.
- Prepares presentations and delivers oversight reports. Reports status to leadership, and escalates changes, issues, and risks for resolution as needed.
- Takes initiative, thinks analytically, and works independent of supervision as appropriate or needed.
- Stays current with technology, processes, and best practices and leverages knowledge to identify opportunities for training and process improvement.
- Develops, formulates, recommends, and implements decisions regarding policy, standards methods, procedures, and functions.
- Additional duties as assigned.
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Minimum Qualifications:
- Bachelor's degree from an accredited institution or equivalent work experience
- Ability to communicate verbally and in writing in a clear, concise, grammatically correct, and professional manner
- Proven experience driving business automation projects through phases such as initial business analysis, requirements gathering, development, architecture design, implementation and configuration, integration efforts and ongoing support to end-users.
- Change management experience that includes defining scope of a project, adhering to appropriate enterprise SDLC requirements, and winning the buy-in of department management and employees.
- Prior experience working on cross-functional, transformational, and/or other significant complex projects.
- Strong understanding of business process management and integration methods and tools
- High school diploma or GED from an accredited institution
Preferred Qualifications:
- Experience leading large scale change initiative in a health plan setting
- Demonstrated understanding and practical experience using Agile methodologies. Exposure to Scaled Agile (SAFe) preferred.
- Experience working with health plan operations and IT
- Experience working as a project manager in a healthcare setting
- Experience with adult learning and development
- Exposure to claims, provider payment, provider onboarding, or contracting operations within a healthcare payor environment.
Hiring Range:
- Greater New York City Area (NY, NJ, CT residents): $100,900 - $145,775
- All Other Locations (within approved locations): $86,500 - $128,690
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.