REMOTE QNXT Configuration Manager

Title : REMOTE QNXT Configuration Manager

Duration : 6+ Months

Position Description:

The Configuration Manager will be responsible for configuration of benefit plans and provider data in the Plan's health information systems. They will lead a team of multi-disciplinary resources that are responsible for the configuration and management of the QNXT core claims processing system, JIVA the medical management platform, and additional core systems as needed.

What You'll Get to Do:

• Provide management and related abilities in support of the corporate goals and objectives.
• Provide leadership and management over the centralized Enterprise System Configuration team for QNXT, NetworX, CES, Optum, and JIVA employed by the Company to include the review of any technical strategies, designs, and implementations, various initiatives and ensure adherence to the short- and longer-term technical roadmap.
• Build, manage, and energize team members with a proven focus on delivering business results with excellent customer service.
• Create technical policies and procedures, and works as, or with, a Project Manager on project cost, resource estimation, tasking, and timely project completion.
• Provide leadership for IT in making effective and efficient use of financial resources through business and financial plans, and ability to implement standard practices in business administration, management, human resources, and GAAP.
• Establish and maintain cooperative working relationships with internal and external customers to solve operational technology issues related to system configuration, technical analytics, or help desk.
• Ensure proper management of the teams fiscal activities; develops budget; manages contracts; establishes and maintains procedures and systems for accurate and timely reporting on fiscal activities.
• Engage in team and department resource planning and work models, performs special projects and other duties as assigned.
• Manage documentation and test services over assigned functional areas to ensure successful change management to include but not limited to new system or application implementations; upgrades; or decommissioning.
• Manage a centralized core system configuration team that creates, modifies, and updates core system configuration changes in support of operational business decisions.
• Create and establish data driven analytics oversight of the organizations core system configuration and activities to ensure accurate and effective system operation.
• Establish, assist, or monitor configuration and business audits of the core system to ensure proper configuration, operational processing, security, or related business and technical needs.
• Ensure that core system configuration is recorded for historical purposes, integrated with the company change management, and executed in accordance with business design and requirements.
• Effectively communicate configuration questions, discrepancies, or issues to Management for immediate resolution.
• Create and establish collaborative and interactive work efforts and projects in support of business and technical configuration efforts.
• Develop tools and programs to support daily configuration management activities ensuring that core system operations are implemented correctly and effectively.
• Create, implement, or support all core system configuration management policies and procedures.
• Be responsible for training staff on core system configuration management to include but not limited to policies, procedures, operations, and oversight.
• Create and maintain a centralized configuration triage process including initial intake, level one and two support, centralized management of third party core system support tickets, and third party defect and roadmap management.
• Manage and perform audits in the following areas: fee schedule updates, service code updates, category of aid, benefit management, service group management, and system synchronization for such areas.
• Provide technical analytics over process improvement for core systems including enhancements to auto adjudication, automatic processing, reduction in manual processing, and adoption of new core system functionality.
• Analyze and elicit process improvement opportunities through software automation while assisting business disciplines to mature through standard operational practices.
• Interpret policy and procedure guidelines and analyze factual information to adapt or modify operational and technology processes in response to changing markets, regulations, or business operations.
• Manage and engage in analytical situations, identify or evaluate alternatives, define or implement technical or manual solutions within standard to meet the needs of the organization's operations.
• Analyze proposed changes of product or process design to determine effect on overall system; business impact; or human resources; and coordinates recording of modifications for change management control.
• Leverage database technologies to create data analytics and reporting in order to gather, review and prepare statistical data in such a manner as to recommend operational changes using technology. For example, compiling charts, tables or graphs to demonstrate Return on Investment (ROI) or efficiency gains.

You'll Bring these Qualifications:

• Bachelor's Degree in Computer Science Information Technology, or related discipline.
• 8 years of Health Plan or Payer experience.
• 5 years of supervisory experience.
• 5 years Medi-Cal (California Medicaid) claims experience.
• Prior managed care experience.
• Be willing to work Pacific Standard Time (PST) hours.
• In-depth knowledge of regulations and procedures governing Medi-Cal and other state sponsored programs as they relate to system configuration.
• Strong knowledge of database concepts and terminology, including interrelationships between data fields.
• Strong knowledge of health information systems related to benefit plan and provider setup.
• Strong knowledge of contract components and language.
• Strong knowledge in at least four health plan functional areas, such as Authorizations, Claims, Providers, and Membership.
• Knowledgeable of the features, functions and configuration of all QNXT modules or other healthcare claims processing system.