Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 600,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.
UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.
WORKING AT UCARE
Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.
Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 14 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.
CONFIGURATION & CLAIMS OPERATIONS CONFIGURATION SR. MANAGER
Work Location: Work from home
As the Configuration & Claims Operations (CCO) Senior Manager, you will be responsible to manage the coordination, administration, and deployment of configuration management activities related to claims adjudication, pricing, benefits, authorizations, and provider data. Formulate procedures and executes the introduction of system changes to HealthRules claims processing systems to support quality initiatives and speed to market activities. Ensure projects and configuration functions are released on time through stakeholder and cross-functional team collaboration. Function as advisor to the configuration analysis team regarding projects, tasks, operational processes, design, and optimization. Monitor and track all Configuration Team activities to ensure standards are followed with proper documentation, reviews, approvals, testing, and auditing, while adhering to defined turnaround times and quality standards. Partner with other leaders who support configuration lifecycle to maximize process efficiencies for intake, prioritization, communications, and resource utilization.
• Recruit, develop, mentor, and evaluate staff. Establish, communicate, and enforce performance standards and goals, while promoting the increase of team engagement.
• Identify training and coaching needs of staff. Design and implement training/ mentoring plans to best meet departmental and individual initiatives, while developing opportunities to support career development in partnership with Human Resources.
• Direct staff workflow and performance to ensure adherence to service level and quality objectives, policies, and procedures, in addition to sharing important organizational, department and team information with staff.
• Develop, implement, and maintain policies and procedures, work instructions, and other documentation to establish clear and measurable expectations for staff.
• Ensure timely and accurate pricing, benefits, authorization, provider data, provider payment, and claims configuration to support provider and member contracts, state, and federal guidelines and UCare pricing, coverage, and medical policy.
• Develop strategies to simplify and improve configuration to be more efficient, scalable, streamlined, and quicker speed to market.
• Oversee the integration and utilization of new tools, technologies, and processes to support the successful deployment and release of configuration changes.
• Interface across the organization to understand and prioritize improvement areas, and proactively drive changes that will increase team efficiency and accuracy.
• Support the organization with escalation support for claims-related inquiries with a root cause in configuration.
• Serve as a key departmental liaison or lead for interdepartmental committees and work groups, as assigned, in addition to promoting positive experiences with stakeholders.
• Communicate status, accomplishments, metrics, and risks regularly and/or as needed to departmental leadership.
• Other projects and duties as assigned.
Bachelor's degree in business or related field; demonstrated work experience may be considered in lieu of degree.
Five years supervisory/managerial experience. At least five years of configuration experience on HealthRules Payor or a combination of claims processing, healthcare system operations, data analytics and configuration. Must possess working knowledge of managed care operations and expertise of configuration management principles. Experience with business process improvement, project management and methodologies.
Ability to build and maintain relationships across the organization. Strong knowledge of government programs, regulations and benefits. Previous experience with Medicare, Medicaid, or payer reimbursement methodologies and/or payment policies, in addition to familiarity with regulations related to the Affordable Care Act and the HealthCare Exchange. Familiarity with market expansion. Experience working in a managed care organization.
THE UCARE DIFFERENCE
The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.
As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
JOB POST DATE: 5/3/2023