Mid-level industry position
The Manager, Contract Services is responsible for managing the overall management of system configuration with special emphasis on developing and maintaining contract, benefit and authorization set up and managing the claims inventory errors related to configuration set up through utilization of the claims system. This position will have full oversight of all system configurations and staff assigned to the area and manages the overall strategic vision of the system configuration. This position will rely on a number of individuals outside their direct organization to deliver services in support of the contract inventory and review process. This includes Finance, Analytics, Credentialing, Health Care Economics, Clinical, Billing and Enrollment, Claims, Member Services and other services. This position will operationally interact with finance, credentialing, network development, and claims personnel by maintaining, reviewing, loading electronically and accounting for all network management contracts. This position will assist in the development and maintenance for all policies for the department.
- Develops and implements contract, benefit and authorization configuration policies, procedures and forms and drives the overall strategic visions for system configuration
- Participates in the development and implementation of systems that support contract and system configuration, directory production, claims payment, network development, etc.
- Key contributor for compliance initiatives and audits ensuring departmental processes are consistent with CMS, state, URAC, SNP and HEDIS standards and regulations
- Oversees all claims, contract, benefit, and authorization configuration efforts and the personnel responsible for the work
- Participates in process improvement initiatives as identified as a result of a business process review for Network Operations
- Ensures departmental performance metrics are met and reported consistently (production, quality and TAT) on a monthly basis, and measures necessary aspects of operational management of the system configuration functionality
- Acts as a liaison for Market Managers and / or State Directors regarding questions, contract clarification and regular updates. Coordinates and manages monthly market meetings in coordination with the Demo / Credentialing team as needed
- Assists and oversees the development of configuration training programs for contract configuration, benefit configuration and authorization configuration as well as the contract services staff
- Recruits, selects and develops team members and develop direct reporting staff, utilizing available learning tools
- Develops and administers departmental budget annually and as requested
- Manages the G&A expenditures monthly with explanations for large variances
- Coordinates and communicates with department staff to understand and / or improve work flow. Initiates efforts to make improvements or changes as needed.
- Maintains general working knowledge of credentialing policies and procedures to ensure successful interaction with Provider Demo / Credentialing team
- Performs all other related duties as assigned
Bachelor’s degree in Business, Healthcare Administration or related field required (8 additional years of comparable work experience beyond the required years of work experience may be substituted in lieu of a bachelor’s degree)
Five or more years of progressively responsible systems configuration experience in a managed care environment, including three to four years of progressive management experience
Excellent analytical and problem solving skills with effective follow through
Strong verbal and written communication skills
Proficiency in Microsoft Office Outlook, Word, PowerPoint, Excel and Access
More than five years of management-level experience in managed care environment
Ability to lift up to 10 pounds
Ability to push or pull heavy objects using up to pounds of force
Ability to sit for extended periods of time
Ability to stand for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery
Ability to properly drive and operate a company vehicle
Ability to receive and comprehend instructions verbally and/or in writing
Ability to use logical reasoning for simple and complex problem solving
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
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Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
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