Supervisor, Provider and Contract Configuration-REMOTE JOB!
Company: Catapult Solutions Group
Posted on: May 13, 2022
Permanent/Direct Hire role
Candidate must be willing to work West coast working hours!
The Supervisor of Provider and Contracts Configuration has
oversight of the Provider Configuration Team. Areas of
responsibilities include staffing, coaching, performance
supervision, system configuration, auditing, and training.
Incumbent is responsible for provider contract configuration,
capitation and maintenance of Medicare, Medi-Cal, and Medi-Caid fee
schedules in the core claims payment system(s). Individual is also
responsible for implementing any new MSO/IPAs to ensure accurate
claims processing. The individual will also be a lead for various
projects to assess future business goals and objectives to assess
the core systems ability to meet those system needs.Job
- Supervise staff. Select, hire, train and motivate staff to
achieve day-to-day and long- range operational goals. Coordinate
resources required to meet the business units' objectives.
Supervise and own the resolution of escalated issues. Continually
review and appraise the progress and performance of staff and
design developmental programs tailored to meet their career
- Work closely with Senior Executives and staff to assess and
respond to escalated configuration needs.
- Facilitate and mange the supervise the resolution of escalated
configuration issues, including liaise between process and
- Act as Point of Contact for team and business partners to
discuss process improvement opportunities. Accountable for
ownership and resolution of these opportunities.
- Collaborate with Product Owners to ensure that
Provider/Contract Configuration solutions and deliverables are met
- Maintains excellent, proactive, and transparent communication
with leaders, stakeholders, including IT and other business
partners to ensure deliverables are met.
- Ensures SDLC adherence, change management compliance, and
establishes system and configuration standards that are necessary
to support Prospect Medical Systems' business requirements.
- Partners with Director and Executive leaders to integrate
business needs into the development of Portfolios, roadmaps, back
logs, prioritization, requirements, and performance (SLA)
- Supervises and implements Provider/Contract Configuration
operational and configuration approach that improves team quality
metrics and velocity, such as implementation of defined
projects/requirements, conditions of acceptance, Quality Audit (QA)
best practices, UAT and Stakeholder accountability.
- Implement and utilize Agile and Scrum project and operation
processes across all team members, partners, and stakeholders.
- Ability to assist team with benefits configuration and issue
resolution as needed.
- Supervise teams' Provider related "alerts" and workload,
including various claims queues, while monitoring, and maintaining
- Ensure all changes related to new, amended and terminated
provider contracts are applied to provider dictionaries, vendor
contracts, fee schedules and capitation agreements timely and
- Partner with Claims and IT for testing as needed
- Ensure referral rules are updated in various systems for all
networks and specialties.
- Assist team and Auditors with Medicare and Medical Fee schedule
implementation and monitor changes
- Analyzes root cause of errors; communicates errors to the
appropriate business partners and escalates configuration errors,
issues, and/or problems to the Business Unit Director
- Assist team with research and evaluation of system capabilities
required in support of business partner and/or provider business
- Perform as a Configuration systems resource to the team and end
- Report creation, maintenance, and oversight. Assist with
creation of new reports and existing reports(s) maintenance as
needed.QualificationsMinimum Education: The position requires a
bachelor's degree or equivalent combination of education and
experience required.Minimum Experience: Excellent written and
verbal communication skills. Strong project management skills as
well as the ability to supervise multiple complex projects
simultaneously. Strong strategic and analytical skills. Experience
in a Managed Care/IPA or other Healthcare environments a huge plus.
Knowledge of HIPAA compliance issues are vital preferred. Thorough
understanding of ICD-10, CPT and HCPCS codes preferred. Knowledge
of medical terminology preferred. Above average knowledge and
understanding of provider contracts and interpretation and
translation into systematic configuration terms preferred.
Knowledge of conditional logic programming a huge plus. Experience
with IDX preferred. Minimum three to five (3-5) years of related
experience preferred. Proficient in Windows environment with
Microsoft Office Suite, including Word, Excel, and Access, Adobe.
Proficient with Microsoft Outlook or other E-mail and scheduling
products. Knowledge of basic Internet terminology and
functionality. Req. Certification/Licensure: None.
Keywords: Catapult Solutions Group, Garland , Supervisor, Provider and Contract Configuration-REMOTE JOB!, Other , Garland, Texas
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