Manager, Configuration - Health Rules Payor

Key Responsibilities/Duties

• Collaborate with stakeholders and the Business Configuration Team to establish the monitoring criteria and timeframe to execute claim monitoring tied to specific configuration change requests
• Manage a team of analysts to effectively execute testing using data analytics and/or running test scenarios related to system configuration
• Lead the continuous analysis and development of key data metrics that will be shared with business stakeholders for making effective decisions on the optimal use of Health Rules Payor to support business functions
• Provide oversite and facilitation of the Contract Implementation and Reimbursement Committee that works with key stakeholders to obtain business decisions on complex provider reimbursement solutions
• Support the development and execution of adhoc data requests needed to support various business needs
• Other duties and projects as assigned.

Qualifications

EDUCATION:

• 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.

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.

Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

COVID Policy

Please note: As of January 18, 2022, all employees — including remote employees — must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

About the Company

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

This job has been posted by TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID: R5141