The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.
Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
Complies and analyzes departmental production data, shifting priorities as necessary. Collaborate with Project managers when Configuration implementations and process changes. Responsible for the performance of employees and making sure employees complete their duties in a timely and accurate manner. Encourage and motivate employees in a positive way. Communicates well with other employees, provides training and support the Configuration Technicians. Prepares schedules and written performance reviews. Prepares and delivers disciplinary action to address issues related to company policy and/or performance. Make recommendations or decisions about promotions or raises.
1. Manages the configuration of projects related to new or existing business and reviews program documentation for accuracy application. Ensures and completely understands downstream/organization impacts are identified, understood, and communicated.
2. Develops/improves/documents and implements configuration processes/procedures.
3. Collaborates with organization teams regarding new and revised lines of business, identifies possible improvements in application software and makes recommendations to management.
4. Assigns the work of staff, providing direction, support and training as needed. Keeps Manager advised of performance issues and works with Manager to develop employees’ skills, knowledge and abilities.
KEY INDIVIDUAL RESPONSIBILITIES
1. Interprets and applies contract and benefit to the core system software. Understanding of fee schedules applied to the system for correct application.
2. Audits new or existing configuration for reliability and accuracy to identify and correct errors, and collaborates with peers for system correction
3. Open communication across the organization of industry changes related to Medicare/Medi-Cal andserves as a resource for others.
Management experience in a team production environment is required. Provides leadership, direction and oversight to the configuration staff. Ensures and maintains accuracy standards. Reviews and analyzes department production data, shifting priorities as necessary in collaboration with peers. Collaborates with implementations team to maximize system upgrade. Responsible for maintaining departmental responsibilities ensuring that all configuration processes are accurate and timely.
10+ years preferred of management experience in a team production environment.
5+ years required of management experience in a team production environment.
5+ years experience required in healthcare claims environment, adjudicating claims understanding of a manged service organization best practices or as a Business or Systems Analyst in the healthcare industry is preferred.
3 years + experience with a healthcare claims processing system preferred.
Experience of QNXT Claims Processing Systems preferred
Experience working with database management systems, with experience in system migrations preferred.
Bachelors degree in business administration/healthcare administration management with a concentration in information systems or related field preferred.
Relevant work experience may be substituted for educational requirements
Preferred QNXT training certification within the last 2 years.
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