Health Plan Configuration Manager is accountable for and manages a team that reviews and interprets state and CMS regulations and contracts and develops and implements these requirements from a benefit and system configuration perspective. Manages and coordinates the successful execution of new and existing product configuration by working with all functional areas of the company. Oversees performance results of the Configuration Department. This role will be responsible for continuing to enhance and maintain the system platform configuration in support of quality claim processing.

Education & Experience:

• Minimum of associates' degree, bachelor's preferred, or equivalent experience in healthcare claims adjudication logic, database maintenance and project management.
• Advanced problem solving, critical thinking, and process analysis skills to lead teams responsible for client configuration
• Subject matter expertise to produce innovative solutions, and advance understanding of configuration best practices
• Understands the healthcare industry, including competitors, the regulatory environment, and industry trends.
• Must have knowledge of CPT, ICD-9/ICD-10, HCPCS, Revenue Codes and pricing methodologies. Minimum of 5-8 years Health Care industry knowledge and operations (example: claims processing, enrollment, provider file maintenance) with ability to interpret and document business requirements.
• Demonstrated proficiency in processing health care claims and to understanding of claim life cycle.
• Advanced Benefit and fee schedule configuration experience.
• Advanced knowledge of core processing systems in relation to configuration set-up.
• Experience working with government agencies such as CMS, Medicaid, etc. along with interpreting agency and contract requirements.
• Strong computer skills with proficiency in MS Word, Excel, Outlook, and Access, and Visio. PowerSTEPP claims system experience preferred.
• SQL and query skills.
• Excellent communication skills both verbal and written.
• Ability to participate in a team environment.
• Self-starter who requires minimal supervision.

Cook Children's is an EOE/AA, Minority/Female/Disability/Veteran employer