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Claims Configuration Requirements and Audit Manager

OPENING DATE: 11/25/19
CLOSING DATE: 12/16/19 11:59 PM Central Time

JOB TYPE: Full-time

LOCATION: Downtown Minneapolis, Minnesota
DEPARTMENT: Hennepin Health
THE POSITION
Hennepin Health is hiring an experienced manager for Claims Configuration and Audits. In this role, you'll manage a team of business analysts who document business requirements for provider and benefit contract changes and also complete monthly, quarterly, and annual claims end-to-end claim adjudication audits. The ideal candidate must demonstrate an in-depth knowledge of the underlying claims adjudication system data model, Medicaid, and Medicare product configuration and pricing methodologies, provider contract, and agreement expertise. This job is a fit for you, if you are able to use technical management and leadership skills to projects and deliver results 
Location and hours:
Hennepin Health offices are located in the Grain Exchange building, 400 South 4th Street, in downtown Minneapolis, accessible by public transportation and light rail. Work hours will be Monday through Friday, 8 a.m. - 4:30 p.m.

About the position type:
This position is full time, benefit earning position.

In this position, you will:
  • Assess and review new benefit designs and provide solutions that are automatable and minimize manual administration.
  • Supervise ongoing performance management of direct reports including, coaching, employee feedback, performance improvement plans, and individual development plans.
  • Develop and ensure the consistent adherence of operational policy and procedures.
  • Evaluate adherence to plan oversight requirements.
  • Lead requirement gathering sessions and work with the team to document clear concise benefit management and provider network compensation business requirements.
  • Manage the day-to-day audit functions for medical claim adjudication administration.
  • Serve as a liaison between the Hennepin Health business stakeholders to translate business policy, medical prior authorizations, medical health benefits, and provider network compensation into business rules and requirements.
  • Complete monthly, quarterly, and yearly audits including root cause analysis, error correction and reconciliation, and the development and management of claims accuracy reporting.

Need to have:
One of the following:
  • Bachelor's degree or higher in business administration, computer science or an approved field related to the business/position and five years or more of benefit configuration experience in a health plan payer environment.
  • Nine years or more of benefit configuration experience in a health plan payer environment. 
Nice to have:
  • Experience in benefit configuration positions such as benefit configuration design, development, or benefit configuration management in a health plan payer environment. Which includes experience supervising and managing direct reports.
  • Project management or business analysis certification.
  • Experience:
  • In claims configuration.
  • Leading a team.
  • Identifying pattern with quantitative data.
  • Knowledge of:
  • Claims clinical coding (CES Optum).
  • Provider pricing, product, and benefit analysis.
  • Health plan claims processing configuration system (e.g. Facets).
  • Ability to:
  • Work effectively with minor supervision.
  • Manage multiple assignments while maintaining quality standards to meet assigned deadlines.
  • Communicate effectively both verbally and in writing.

About the department:
Hennepin Health is a not-for-profit, state-certified health maintenance organization and an enterprise initiative of Hennepin County. Hennepin Health serves the county's diverse safety net population and publicly funded health care recipients. Its mission is to help people improve their health through personal service; its vision is to become the leader in eliminating health care disparities. Because of Hennepin Health's affiliation with Hennepin County, services for its members are enhanced through a close linkage with social services and other programs offered by the county.  

About Hennepin County:
Hennepin is the largest county government organization in Minnesota. Our employees work every day to improve the health, safety and quality of life for our residents and communities. All of our jobs align to one or more of our overarching goals -- that Hennepin County residents are healthy, protected and safe, self-reliant, assured due process, and mobile.

Our employees receive a combination of generous benefits and positive workplace culture not found at other organizations. This includes meaningful work that impacts our community, competitive pay, work-life balance, a variety of benefits and opportunities to grow. Learn more at www.hennepin.us/employees.
 
Hennepin County envisions an organization where our commitment to diversity and the reduction of disparities is fundamental in providing excellent service to our community.
 
Your future. Made here.

This position is internally classified as an Administrative Manager.

Invitations to interview will be based upon an assessment of education and experience. Final candidates will be required to complete a background check.

NOTE: You must attach a cover letter and resume as part of your application materials to be considered for this position.