Product System Implementation Administrator-Healthcare 24-00609 - Alura Workforce Solutions

Rancho Cucamonga, CA 91730

About the Job

POSITION
Product System Implementation Administrator
Managed Cae Health Plan Experience Required

Position Type: Temporary/Temp-Hire
Schedule : M-F, 8:00 am - 5 pm (REMOTE)
Assignment Length: 6-Months

DESCRIPTION

Reporting to the Senior Director, Product Configuration and Implementation, the Product System Execution Administrator will lead strategic and functional design of Commercial business rules, user solutions, end to end technical configuration processes, and an ongoing technical strategy. Responsible to master and scale new technology to ensure successful system migrations. Implements centralized desk level procedures and data integrity measures. Develops strategic plan to optimize configuration data structures, partnering with IT to identify requirements and technology for best-in-class code set builds and maintenance. Develops vision for end-to-end workflow management tools for full upstream and downstream visibility.

Key Responsibilities

Lead strategy development, roadmap, and functional design for Commercial Product Implementation, ensuring business readiness.
Design processes that contribute to accurate, consistent, and timely downstream financial and operational outcomes.
Partner with Product Development, Contracting and Configuration teams to research and interpret provisions, synthesize coding and rules, and compile implementation strategies and rule definitions on an ongoing basis.
Facilitate operational readiness assessments for new contracts and review appropriateness of non-standard terms.
Implement a quality plan with measurable, repeatable audits, test scenarios, desk level procedures, and documentation requirements for Commercial Product Implementation.
Conduct user research to continuously improve experience and keep processes up to date; maintain effective governance participation and touchpoints, develop high performing matrix teams.
Build and manage multi-year strategic roadmaps to facilitate change, including business implications of system consolidations.
Partner with internal IT and vendors to communicate the vision and optimize user experience; consolidating user needs and directing technical builds to support the product development lifecycle.
Monitor and address quality, SLAs and process performance internally and with vendors; implement quality improvement plans.

REQUIREMENTS

Eight (8) years of total health plan experience inclusive of:

Five (5) years of Commercial configuration; including DOFRs
Experience driving strategic initiatives to optimize quality and processes
Communicating user needs to IT for initiatives within Agile framework
Experience driving system changes to improve quality outcomes and efficiency preferred
Experience identifying and facilitating development of best practices and desk level procedures
Facilitating innovative change and influencing stakeholders
Continuous improvement mindset with experience optimizing handoffs for end-to-end implementation process
Facilitating contract implementation processes across a matrix team, demonstrated skill improving process quality and efficiency
Experience with health plan data including professional and facility claims, encounters, provider data and fee schedules
Hands-on configuration experience.

Bachelor's degree from an accredited institution required.
In lieu of the required degree, a minimum of four (4) years of additional significant, demonstrated health plan configuration, process improvement and product owner experience across multiple products/ lines of business is required for this position. Extensive experience in configuration and contract implementation across health plan functions and demonstrated technical and quality/ process improvement experience. This experience is in addition to the minimum years listed in the Experience Requirements above.
Complete Scrum Product Owner Certification within first year of employment.

Valid California Driver's License.

Expert knowledge of:
HRP and Source/ experience configuring HRP
Configuration data workflow and workflow tools is a plus
Commercial Health Plans (required)
Government Health Plans (preferred)
Multiple Payment Models: Fee for Service/ HMO APMs
Healthcare technology especially claims and configuration systems
How regulations, legislation, non-standard contract agreements and general contract terms (Product and Provider) translate to executable rules.
How contracts and codified rules impact claim processing
End-to-end understanding of contract development
IT and vendor/ business dynamics

INDH

Source : Alura Workforce Solutions