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.
HEALTHRULES CONFIGURATION ARCHITECT
Work Location: Work from Home or Office for Your Day
As a HealthRules Configuration Architect, you will be responsible for the design, oversight, and technical aspects of all HealthRules Configuration. Responsible to assist in development of scalable configuration practices, enhancement of manual processes through automation, and is the overall subject matter expert of HealthRules System Functionality. In addition, this role will need expertise in configuration related to pricing, benefits, billing & enrollment, provider data, message codes, validation policies, claims configuration, and surrounds systems that support accurate adjudication. The surround systems include but not limited to EDI, claims editing, and pricers. Bring subject matter experts together, collaborate, creating solution options and recommendations across the body of new requests, break/fix, and projects. Experience overseeing the development and architecture of best system practices for configuration and the implementation of new functionality to support business initiatives is strongly preferred. Train team members on system configuration, creating documentation to support operational processes, develop testing strategies for accurate system deployment and work with stakeholders at all levels throughout the organization for the successful interpretation and implementation of complex requirements.
• Architect scalable configuration practices and surrounding systems, maintaining an understanding of current UCare HealthRules Payor setup, contracts, products, requirements, and policies.
• Collaborate with various departments and technical teams for the development of automated and refined processes to support operational efficiencies.
• Analyze, configure, implement, and maintain HealthRules Payor to support changes in contracts, products, legislation, and UCare policies and procedures, ensuring timely maintenance and updates of configuration.
• Train others on new and existing HealthRules Payor and third-party product releases, functionality, modules, and updates.
• Assist in the development of test scenarios for changes and/or projects. Manage the timely resolution of open testing bugs and issues. Develop and monitor postproduction audit reports to ensure the intent of change and/or project requirements is being met.
• Develop and maintain configuration documentation and communicate changes, as appropriate.
• Collaborate with Technical Business Analyst, UAT and QA to create detailed functional requirements that support and align to business requirements and testing scenarios.
• Recommend and draft new and updated procedures to maximize the use of HealthRules Payor and other third-party products to improve efficiency.
• Act as overall subject matter expert for configuration functionality on the HealthRules Platform to support the successful implementation of new business strategy.
• Inform leader and peers of business and functional changes that will impact UCare. Research and recommend methods to improve or implement necessary changes in a prompt and efficient manner.
• Other projects and duties as assigned.
Bachelor's degree in business or health care preferred; demonstrated work experience may be considered in lieu of degree.
Seven years of configuration experience on a claims processing platform.
Must possess working knowledge of managed care operations, the HealthRules Payor Software, and subject matter expertise of all functions related to configuration management. Has successfully implemented and had oversight of new system functionality and the implementation of configuration related to business strategies or market expansion.
Strong knowledge of government programs, regulations and benefits. Previous experience with CMS, DHS 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 the current market and network that UCare currently offers products in. Design of configuration architecture for the successful management of system updates on HealthRules Payor.
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: 08/21/2023