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Location:

Avera Health Plans

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

The Avera Health Plan Configuration Manager oversees the configuration of the Plan's claims system and related technologies to ensure efficient and accurate processing for health plan customers, including our members and providers. This role will lead a team responsible to analyze plan designs and translate them into system configuration of high quality. This role also involves maintaining benefit categories, networks, and other configuration structures. The Manager of Configurations is responsible for the performance management of all Configurations staff. This position is responsible for planning, organizing and coordinating the daily operations of the Configurations team. Timeliness and accuracy of configurations set up, testing and execution to ensure compliance with Avera Health Plans policies and procedures and quality performance standards is critical in this position. Responsible for ensuring configuration management, design, requirements traceability, and audits controls meet state and federal regulatory requirements. Develops and improves workflows and business processes within area(s) to improve customer service, decrease operational costs, and improve overall quality.

What you will do

+ Lead and implement processes to measure and monitor the performance of the Configuration team for the purposes of education, training and quality of service improvements.

+ Reviews and evaluates policies and procedures of the health plan to assure they are consistently and accurately interpreted and implemented with the core system. Adhere to all applicable rules, regulations and standards.

+ Manage and assist with organizing configuration changes to multiple environments to reduce the potential for migration conflicts and maintain consistency.

+ Ensure accurate and timely implementation and maintenance of all system configuration requests using validation and audit strategies.

+ Create and implement audit protocols within the configurations department to ensure high quality and consistency of core claims processing and ensure integrity of audit protocols via the variance process to own and understand errors made and to discourage repeating such errors.

+ Understand the business process activities that utilize the core system to support business requirements and initiatives and collaborate with various business units to know, understand and implement strategic goals.

+ Guide the configuration team, providing clear communication and direction for all new and ongoing configuration, projects or company initiatives.

+ Understand the end to end solution design for the core claims processing software, including the integrations with other platforms that interface with the software. Maintain a working knowledge of core processing software existing functionality, changes and upgrades.

+ Oversee the processes of new code set reviews and setup in both internal and external facing environments.

+ Liaison with the software vendor(s) on matters involving the claims management system, business fulfillment, and claim editing.

+ Responsibilities include interviewing, hiring, developing, training, and retaining employees; planning, assigning, and leading work; appraising performance; rewarding and coaching employees; addressing complaints and resolving problems.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

+ 4-6 years Health insurance experience, including experience with claims systems, EDI files, and related technologies.

+ Demonstrated ability to lead, motivate, and manage a team.

+ Ability to analyze plan designs, identify issues, and propose solutions. Ability to identify and resolve configurations issues.

+ Ability to effectively communicate with team members and cross-functionally with key stakeholders.

Preferred Education, License/Certification, or Work Experience:

+ Bachelor's Business Administration

Expectations and Standards

+ Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.

+ Promote Avera’s values of compassion, hospitality, and stewardship.

+ Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.

+ Maintain confidentiality.

+ Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.

+ Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

+ PTO available day 1 for eligible hires.

+ Free health insurance options, for full-time single coverage on Avera High Deductible Health Plan

+ Up to 5% employer matching contribution for retirement

+ Career development guided by hands-on training and mentorship

_Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to_ [email protected]_ _._

At Avera, the way you are treated as an employee translates into the compassionate care you deliver to patients and team members. Because we consider health care a ministry, you can live out your faith, uphold the dignity and respect of all persons while not compromising high-quality services. Join us in making a positive impact on moving health forward.

The policy of Avera to provide opportunities for all qualified employees or applicants without regard to disability and to provide reasonable accommodations for all employees or applicants who may be disabled. Avera is committed to ensuring compliance in accordance with the Americans with Disability Act. For assistance, please contact HR Now at 605-504-4444.

Additional Notices:

For TTY, dial 711

Avera is an Equal Opportunity/Affirmative Action Employer: Minority/Female/Disabled/Veteran/Sexual Orientation/Gender Identity.