Manager, Configuration - Claims Systems

Company: Tufts Health Plan

General Information
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Job Description

The Manager of HealthRules Payor (HRP) Configuration is responsible for defining objectives, prioritizing responsibilities, and overseeing the successful execution of all configuration activities in Health Rules Designer. The manager must demonstrate strong knowledge of the health care business with technical, analytical, communication, and problem-solving skills. The manager is responsible for:
* Ensuring the development and maintenance of efficient and effective interfaces with internal and external business associates
* Business architecture of the Health Rules Designer application to ensure that we are making optimal use of system capabilities, flexible in a manner that is scalable for future Lines of Business, and aligns to business needs
* Managing and mentoring staff
* Working collaboratively with business leadership to improve efficiency and customer satisfaction

Architectural Oversight:

Primary duties include, but are not limited to:

* Manage and develop impact assessment of new configuration initiatives, programs, products and alignment with system capabilities and continue to meet regulatory requirements
* Lead the development, review, and clarification of business configuration requirements to ensure they align with HRP and integration design
* Support the development, review and acceptance of business process flows that highlight user interactions with Health Rules Payor configuration provisions. Evaluate and monitor configuration requests, processes and governance approach to be used across all HRP components
* Document the high level and reference detail documents that address the configuration design
* Distribute and gain acceptance of the Configuration design document with Business Owners
* Collaborate with teams that support Claim Edit and DRG Grouper configuration to ensure that the end to end business function is effective and efficient across applications
* Participate in the validation of technical specifications and collaborate with IT on establishment of end to end solution design between Health Rules Payor and the enterprise management systems
* Coordinate development and implementation of test cases, and manage post implementation issue resolution of configuration items
* Develop configuration implementation plan
* Work with the Deployment Manager on the migration of configuration from the appropriate stage to production
* Work with QA team on completion of testing to confirm configuration migration was successful
* Participate in User group, vendor forums , and review of product communication to ensure THP is optimally configuring the product to meet ongoing business needs
* Participate in and support the development of configuration management systems and governance
Staff Management :

Oversee the management of staff and cross-functional business relationships:
* Manage and coach staff to meet deadlines and achieve high professional standards
Hold staff accountable for deliverables, productivity, and stakeholder needs
* Participate in cross-functional partnerships, and work groups including but not limited to Sales, Marketing, IT, Claims, when necessary

Configuration Management
* Establish and maintain the use of a configuration management system that will identify and manage the configuration work requests from initiation through deployment with the ability to report on status, resource allocation and capacity.

* Develop general configurations team operational reports, as needed
* Support operational report designs as needed by providing configuration knowledge *

EDUCATION: (Minimum education & certifications required)
Bachelors Degree required, Masters Degree preferred.

EXPERIENCE: (Minimum 5-7)
Managed care experience preferred. Significant experience managing projects, business process assessment, implementing change, and leading people required.

SKILL REQUIREMENTS: (Include interpersonal skills)
Work cooperatively as a team member across multiple levels within the organization
Key Competencies:
* Results orientation - drives to meet business goals
* Systems thinking -- must understand overall THP systems/people and the impact of business changes particularly as they affect internal and external business partners
* Influencing others and ability to quickly build partnerships particularly those outside of direct reporting relationships
* Ability to work independently with the executive level, both internally and externally
* Strong communications skills (formal and informal, written and verbal)
* Ability to handle multiple demands--must be able to balance multiple priorities
* Quick learner who can act as a representative , advocate , and consultant
* Project management skills
* Problem solving based on understanding of system capabilities and business need with deep knowledge of Health Rules Payor
* Business Architect who has a broad knowledge of many business functions and how they interact
* Ability to collaborate with Operations to develop business process workflows and supporting documentation.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (Include special requirements: lifting, travel,

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
Job Requirements