Manager, Claims Systems Configuration (Remote)
City/StateGlen Allen, VAOverviewWork ShiftFirst (Days) (United States of America)Sentara Health Plan is currently hiring a Manager, Claims Systems Configuration!This is a Full-Time position with day shift hours and great benefits!Work Location:
Remote opportunities available in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, WyomingJob ResponsibilitiesManages all activities involving system benefit development and implementation, contract administration, coding compliance, fee schedule implementation, provider network database management and quality assurance, internal and external auditing of the key processes, system compliance and acceptance testing, and process improvements designed to increase operational effectiveness.
Manage the team that is responsible for loading accurate, current fee schedules, managing configuration for pricing, Medicare Medicaid.
Job Requirements:
Required- Bachelor's degree Required - 3 years of relevant experience in the Health Insurance or Health plan Industry Required - 3 years of relevant experience in the Health Care Required - Experience with QNXT Working with claims coming in from providers and understanding provider reimbursement for MEDICAID and MEDICARE medical claims is preferred Experience with QNXT claims processing system, and Networx pricing system experience is preferred.
Experience with Facets.
Provider Pricing experience Need to be very adaptable
Benefits:
Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks, and more.
Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind.
Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next.
You have a variety of options for medical, dental and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave.
Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.
For compliance with the Washington State laws, the full pay range of the position for the state of Washington is posted as $84,717.
36 to $113,5539.
04 with a target hiring range of $84,717.
36 to $107,168.
88.
Sentara Health Plans is the health insurance division of Sentara Healthcare.
Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.
With more than 30 years' experience in the insurance business and 20 years' experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services - all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity.
Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!To apply, please go to www.
sentaracareers.
com and use the following as your Keyword Search:
162597BR#IndeedMonsterTalroo-ITIndeedMonsterTalroo-Health PlanKeywords:
Provider Pricing, Networx, QNXT, Facets, Claims, enrollment, encounters, Claims, Healthcare, Health Plan, Remote, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, WyomingJob SummaryThe Ops Support/Systems Administration manager manages all business activities involving system development and implementation, provider and hospital contract configuration, coding compliance and fee schedule implementation.
The manager will work collaboratively across the organization to address business needs, determine configuration changes needed and how the changes impact other areas.
They will troubleshoot system related issues and should be proficient in analyzing business needs, determining necessary configuration, and developing test scenarios to ensure accurate and complete testing.
They will manage all applications and or interfaces used to support claims processing and pricing.
They will be responsible for developing staff and documenting processes and procedures to support business needs.
They will manage the configuration of the systems by enforcing a strict change management policy and a clear documentation process.
In addition, they will work with the Quality & Integrity team to ensure that system configuration changes are functioning properly upon post production release.
Qualifications:
BLD - Bachelor's Level Degree (Required)Healthcare, Health Insurance IndustrySkillsActive Learning, Active Learning, Active Listening, Communication, Complex Problem Solving, Coordination, Critical Thinking, Judgment and Decision Making, Leadership, Learning Strategies, Mathematics, Mgmt of Financial Resources, Mgmt of Material Resources, Mgmt of Staff Resources, Microsoft Excel, Microsoft Word, Monitoring, Persuasion, Project Management, Quality Control Analysis, Reading Comprehension, Science, Service Orientation, Social Perceptiveness, Speaking
5 more Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce.
Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.
gov for further information.
In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.
In support of our mission to improve health every day, this is a tobacco-free environment.
Recommended Skills Active Listening Auditing Business Requirements Change Management Claim Processing Communication Estimated Salary: $20 to $28 per hour based on qualifications.
Remote opportunities available in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, WyomingJob ResponsibilitiesManages all activities involving system benefit development and implementation, contract administration, coding compliance, fee schedule implementation, provider network database management and quality assurance, internal and external auditing of the key processes, system compliance and acceptance testing, and process improvements designed to increase operational effectiveness.
Manage the team that is responsible for loading accurate, current fee schedules, managing configuration for pricing, Medicare Medicaid.
Job Requirements:
Required- Bachelor's degree Required - 3 years of relevant experience in the Health Insurance or Health plan Industry Required - 3 years of relevant experience in the Health Care Required - Experience with QNXT Working with claims coming in from providers and understanding provider reimbursement for MEDICAID and MEDICARE medical claims is preferred Experience with QNXT claims processing system, and Networx pricing system experience is preferred.
Experience with Facets.
Provider Pricing experience Need to be very adaptable
Benefits:
Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks, and more.
Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind.
Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next.
You have a variety of options for medical, dental and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave.
Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.
For compliance with the Washington State laws, the full pay range of the position for the state of Washington is posted as $84,717.
36 to $113,5539.
04 with a target hiring range of $84,717.
36 to $107,168.
88.
Sentara Health Plans is the health insurance division of Sentara Healthcare.
Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.
With more than 30 years' experience in the insurance business and 20 years' experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services - all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity.
Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!To apply, please go to www.
sentaracareers.
com and use the following as your Keyword Search:
162597BR#IndeedMonsterTalroo-ITIndeedMonsterTalroo-Health PlanKeywords:
Provider Pricing, Networx, QNXT, Facets, Claims, enrollment, encounters, Claims, Healthcare, Health Plan, Remote, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, WyomingJob SummaryThe Ops Support/Systems Administration manager manages all business activities involving system development and implementation, provider and hospital contract configuration, coding compliance and fee schedule implementation.
The manager will work collaboratively across the organization to address business needs, determine configuration changes needed and how the changes impact other areas.
They will troubleshoot system related issues and should be proficient in analyzing business needs, determining necessary configuration, and developing test scenarios to ensure accurate and complete testing.
They will manage all applications and or interfaces used to support claims processing and pricing.
They will be responsible for developing staff and documenting processes and procedures to support business needs.
They will manage the configuration of the systems by enforcing a strict change management policy and a clear documentation process.
In addition, they will work with the Quality & Integrity team to ensure that system configuration changes are functioning properly upon post production release.
Qualifications:
BLD - Bachelor's Level Degree (Required)Healthcare, Health Insurance IndustrySkillsActive Learning, Active Learning, Active Listening, Communication, Complex Problem Solving, Coordination, Critical Thinking, Judgment and Decision Making, Leadership, Learning Strategies, Mathematics, Mgmt of Financial Resources, Mgmt of Material Resources, Mgmt of Staff Resources, Microsoft Excel, Microsoft Word, Monitoring, Persuasion, Project Management, Quality Control Analysis, Reading Comprehension, Science, Service Orientation, Social Perceptiveness, Speaking
5 more Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce.
Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.
gov for further information.
In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.
In support of our mission to improve health every day, this is a tobacco-free environment.
Recommended Skills Active Listening Auditing Business Requirements Change Management Claim Processing Communication Estimated Salary: $20 to $28 per hour based on qualifications.
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