Job Summary:
The Manager, BC & S Implementations is responsible to oversee implementation of all new products and LOBs for the development of benefit requirements and supporting code sets and execute within the appropriate timeframes and deadlines with highest level of accuracy.
Essential Functions:
- Responsible for managing the creation, scoping, planning, prioritization, and delivery of all BC&S implementation work for the organization
- Manage the end-to-end BC&S implementations by participating in discovery sessions, creating global design decisions, and documenting best practices for coding structures
- Partner with key business partners (Market and Product leadership, Regulatory partners, Configuration, Utilization Management, etc.) to ensure accuracy of plan designs and covered services
- Responsible for all performance management activities for direct reports, including but not limited to mentoring, coaching, training, holding to performance metrics, quality standards, etc.
- Ensure designed member benefits are compliant with all regulations across all product lines (Essential Health Benefits, CMS requirements, mental health parity, etc.)
- Manage departmental workflow for design, maintenance, and inquiries
- Partner with market and analytics teams to ensure necessary information is available to evaluate benefits and drive optimization
- Serve as departmental liaison on BC&S needs of the organization
- Resolve resource capacity constraints to ensure deadlines are met
- Develop and utilize reports to analyze data to assist with issue resolution and impact analysis
- Effective identification of business problems, assessment of proposed solutions to those problems, and understanding of the needs of business partners
- Manage the Audit and Process team and functions
- Collaborate with Team Leads to resolve conflicts of audit result rebuttals
- Develop and document departmental processes and workflows
- Perform any other job duties as requested
Education and Experience:
- Bachelor's degree or equivalent years of relevant work experience is required
- Minimum of seven (7) years of experience in a healthcare payer organization required, preferably in Medicare Advantage, Medicaid, and/or Health Insurance Exchange settings
- Medical benefit plan design, medical policy development, claims processing and/or configuration experience in Facets or equivalent system is required
- Previous supervisory or management experience is required
Competencies, Knowledge, and Skills:
- Understanding of CPT, HCPCs, ICD-CM and Revenue codes
- Deep and broad understanding of claims processing lifecycle
- High level understanding of end-to-end health plan operations and interdependencies
- Claims administration system knowledge/training preferred
- Understanding of prospective and alternative payment methodologies preferred
- Ability to lead process development and improvement and change management
- Advanced proficiency with Microsoft Suite to include Word, Excel, and PowerPoint
- Excellent problem-solving skills with attention to detail
- Project management skills preferred
- Auditing skills
- Strong service orientation and consulting skills
- Highly developed communication skills (written and verbal)
- Proven ability to work collaboratively with all levels of management and external stakeholders
- Proven ability to juggle multiple, complex priorities within a changing environment
- Ability to develop, prioritize and accomplish goals
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
- May be required to travel less than 25% of the time
Compensation Range:
$92,300.00 - $161,600.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
