Conducts functions of the Business Configuration administration team which includes design, development & testing activities of all components within the departmental scope of Business configuration. Collaborates w/ everyone from leadership through front line staff from Key departmental constituents to execute efficient & quality based process works flows & policies. Executes & delivers the collection, interpretation, analysis, & organization of information & data necessary to deliver on established organizational & departmental goals within the scope of responsibility. Participates in cross functional teams focused on performance improvements needed in HPSA operations This position executes on activities to integrate knowledge of business drivers, operations, IT, change management, strategic & tactical planning in support of key business initiatives. Maintains & supports a culture of compliance, ethics & integrity. Maintains knowledge of policies & procedures & performs in accordance w/ the Principles of Responsibilities & applicable regulatory requirements, external laws & accreditation standards. Appropriately reports observed fraud or abuse.
Essential Functions:
- Executes Business Configuration team job duties meeting established minimum level quality metrics
- Executes Configuration team functions in Provider Contracts & Pricing, Benefits configuration, General configuration, Authorization configuration, System security, COB, Quality Control, Data & reporting, System maintenance & other areas as assigned
- Participates in projects related to design, implementation & maintenance of Xcelys application & related upgrades
- Actively engages in continuous interactions w/ other departments (Claims Administration, KPIT, Benefit Administration & Provider Contracting, ETC.) through process development to deliver on customer needs & expedite responses to system problems solutions
- Ensures that assigned departmental policies & procedures are documented & current
- Supports management in ensuring that all activities conform to minimum regulatory, state, federal, SOX & other compliance related requirements
- Participates in best practice sharing w/ other regional/National configuration teams utilizing the Xcelys platform
- Participates in development of & executes on set-up of new business processes/work flows & departmental structure for Xcelys configuration team to ensure Quality results are achieved for all areas of accountability
- Responsible for utilizing data reporting to inform decisions for configuration to ensure continuous improvement in efficiency & quality to achieve department & organizational goals
- Other duties as assigned
- In addition to defined technical requirements, accountable for consistently demonstrating service behaviors & principles defined by the KP Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives
- Also accountable for consistently demonstrating the knowledge, skills, abilities, & behaviors necessary to provide superior & culturally sensitive service to each other, to our members, & to purchasers, contracted providers & vendors
- Maintains current information & knowledge of all applicable Kaiser policies, local, state & federal laws & regulations, & accreditation standards
- Ensures that the training activities incorporate all applicable KP policies, local, state & federal laws & regulations, & accreditation standards
- Supervises assigned staff
- This includes interviewing, selecting, training, motivating, evaluating, counseling, disciplining & terminating in compliance w/ EEO/AA goals & personnel policies of the organization
Qualifications:
Basic Qualifications:
- 4 years of Health Care related business experience required
- 2 years technical systems experience required
- Bachelor's degree in business administration, computer science, or related area. Equivalent related experience may be considered
- Strong problem solving & diagnostic skills required
- Excellent interpersonal, verbal & written skills required w/ an emphasis on attention to detail & quality control
- Strong process/work flow development & execution skills required
- Ability to adapt to constantly changing environments & priorities required
Preferred Qualifications:
- Prefer health care related business experience in benefits administration or provider contracts
- Experience in system configuration activities in health care Business Administration strongly preferred
- Experience w/ Perot Diamond 950 or Peradigm/Xcelys System or a similar claims system preferred
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.