Job Description

Claims And Provider Payment Modernization Manager

The Claims and Provider Payment Modernization Manager represents Healthfirst Operations in the support of defined claims-related and/or provider payment modernization efforts. S/he will have business oversight of capabilities as they transition from legacy models and systems into new standard configurations and new systems. This role carries strategic importance and will help generate new operational processes and operating models. The role requires a strong understanding of program and project management best practices, including timeliness, issue resolution, risk mitigation, communications, and stakeholder management.

Duties & Responsibilities:

• Manages assigned initiatives, including workplan development, stakeholder management, change management, implementation, success measurement, and communication of project status to business stakeholders.
• Partners with IT and Delivery teams in the delivery of technical components within existing frameworks and methodologies required by Healthfirst.
• Works across multiple departments in the development of business requirements and associated artifacts by developing a deep understanding of business needs, and by collaborating closely with peers, leaders, and staff throughout Operations to ensure the appropriate parties are contributing.
• Works with team members to develop comprehensive process improvement and implementation plans, assisting with operational readiness efforts to ensure seamless transition from legacy to new.
• Prepares presentations and delivers oversight reports. Reports status to leadership, and escalates changes, issues, and risks for resolution as needed.
• Takes initiative, thinks analytically, and works independent of supervision as appropriate or needed. Stays current with technology, processes, and best practices and leverages knowledge to identify opportunities for training and process improvement.
• Develops, formulates, recommends, and implements decisions regarding policy, standards methods, procedures, and functions.

Minimum Qualifications:

• Bachelor's degree from an accredited institution or equivalent work experience
• Ability to communicate verbally and in writing in a clear, concise, grammatically correct, and professional manner
• Proven experience driving business automation projects through phases such as initial business analysis, requirements gathering, development, architecture design, implementation and configuration, integration efforts and ongoing support to end-users.
• Change management experience that includes defining scope of a project, adhering to appropriate enterprise SDLC requirements, and winning the buy-in of department management and employees.
• Prior experience working on cross-functional, transformational, and/or other significant complex projects.
• Strong understanding of business process management and integration methods and tools

Preferred Qualifications:

• Experience leading large scale change initiative in a health plan setting
• Demonstrated understanding and practical experience using Agile methodologies. Exposure to Scaled Agile (SAFe) preferred.
• Experience working with health plan operations and IT
• Experience working as a project manager in a healthcare setting
• Experience with adult learning and development
• Exposure to claims, provider payment, provider onboarding, or contracting operations within a healthcare payor environment.

HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis.

Healthfirst will never ask you for money during the recruitment or onboarding process.

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