Configuration Specialist

SCAN Group; Long Beach (CA); Remote; USD 125,000 - 150,000; Full time

Job summary

Join a mission-driven organization dedicated to improving senior healthcare. In this role, you will support critical operational systems, enhancing processes and ensuring customer satisfaction. Your expertise will drive innovative solutions in a dynamic environment, allowing you to make a meaningful impact on the lives of older adults. With a commitment to employee growth and a robust wellness program, this opportunity offers a fulfilling career path where you can truly make a difference.

Benefits

Annual Employee Bonus Program

Robust Wellness Program

Generous Paid Time Off (PTO)

11 Paid Holidays Plus 1 Floating Holiday

Excellent 401(k) Retirement Plan with Employer Match

Employee Recognition Program

Tuition Reimbursement

Qualifications

• 3-5 years of configuration experience in healthcare.
• Prior experience in healthcare claims and customer service.

Responsibilities

• Support Enrollment, Billing, Claims, and Customer Service systems.
• Lead process improvement projects and enhance system capabilities.

Skills

Healthcare Claims Knowledge

Communication Skills

Problem Solving

Organizational Skills

Project Management

Financial Analysis

Flexibility in Dynamic Environments

Education

Bachelor's Degree

Equivalent Experience

Tools

MS Office (Excel, Word, Outlook, Access, PowerPoint, Project, Visio)

Claims System Configuration

Job description

Description

About SCAN

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 285,000 members in California, Arizona, Nevada, and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn; Facebook; and Twitter.

The Job

Provide support of Enrollment, Billing, Authorizations, Claims, Member Services, Customer Service, Capitation, Finance and other business area processing systems in all environments by planning, development, testing and implementation of system configuration changes and enhancements. The position functions to support operational needs and requirements. Facilitate processing improvement projects. Maximize the Department's administrative and technical capabilities by leading cross-functional and process improvement projects.

You Will

• Performs software component configuration, analysis, monitoring, and performance optimization to maintain and improve the processing system.


• Investigates and diagnoses issues.


• Working with Manager, designs, develops, debugs, tests, maintains and improves automated processes.


• Works with Management, business owners and IT to develop strategic solutions, making recommendations to implement as appropriate.


• Acts as a Subject Matter Expert for system capability for Enrollment, Billing, Authorizations, Claims, Member Services, Customer Service, Capitation, Finance and other business area supported by the processing systems


• Develops and fosters a customer satisfaction focus within the department to strengthen and build relationships for both internal and external customers.


• Improves department processes by reviewing objectives and specifications, evaluating proposed changes, making recommendations, and leading projects.


• Makes recommendations for system enhancements by providing business requirements including cases, examples, and/or test results to management for consideration.


• Implements process improvements by creating project work plans, financial estimates, and identifying time and resource requirements; by facilitating cross-functional teams; and by providing timely project updates. Creates test plans, including scripts, data, resources, timelines and reporting results


• Ensures change control procedures are followed.


• Provides recommendations for claims processing policies and procedures and training, including flowcharts and other related material.


• Develops written policies and procedures and flowcharts for claims support unit processes and system configuration changes.


• Develops meaningful reports, establishing baseline performance and communicating effectiveness of system changes to management


• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.


• Contributes to team effort through knowledge sharing and cross training of unit activities, system changes and problem resolution.


• Supports other areas within Shared Services as needed.


• Actively support the achievement of SCAN's Vision and Goals.


• Other duties as assigned.

Your Qualifications

• Bachelor's Degree, or comparable combination of education/experience and/or training will be considered equivalent to the education.


• 3 - 5 years of configuration experience.


• 2 years of relevant project experience and ability to conduct project related financial analysis


• Prior Healthcare Claims, Enrollment, Healthcare Services, customer service experience and working knowledge.


• knowledge of claims system configuration, including code sets, fee schedules, CPT, ICD9 - 10, benefit setup


• Proficient with MS Office applications, including MS Excel, Word, Outlook, Access, PowerPoint, Microsoft project and Visio.


• Knowledge of CMS, Medical, HIPAA, DOFR, AHCCCS, provider contracting and pricing is highly desirable.


• Knowledge of pricing and bundling tools.


• Ability to be flexible and adjust in a fast-paced and dynamic environment.


• Demonstrated ability to communicate with all levels of staff.


• Excellent verbal and written communication skills.


• Excellent problem solving and organizational skills.

What's in it for you?

• Base Pay Range: $25.38 - $40.65 (Hourly)


• Work Mode: Remote


• An annual employee bonus program


• Robust Wellness Program


• Generous paid-time-off (PTO)


• 11 paid holidays per year, plus 1 additional floating holiday


• Excellent 401(k) Retirement Saving Plan with employer match


• Robust employee recognition program


• Tuition reimbursement


• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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