Director of Provider Contract Configuration / Hybrid

Job DescriptionJob DescriptionFor more than 30 years, this health plan has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. They provide the highest quality healthcare services to of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products.

Director of Provider Contract Configuration / Hybrid
Hybrid position (requiring 2 days in the Manhattan office and 3 days remote)
Position Overview
The Director of Provider Contract Configuration is responsible for evaluating operational processes and procedures for process improvement of the Organizations Core Applications. Will work with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to setup systems to ensure accuracy of payments processing.
Job Description

• Oversee development and implementation of short/long term business objectives
• Direct and support initiatives to focus on projects with plan wide benefit in accordance with corporate budgetary objectives
• Ensure provider contracts are configured timely and accurately
• Oversee functions performed by delegated vendor(s) as it relates to benefit configuration, claims processing, provider setup and account payable system
• Manage activities and communications between key business stakeholders and Core System Vendor for implementation of new systems and optimization of current systems
• Develop and oversee SDLC methodology, including business requirements creation and sign-off, Quality Assurance, User Acceptance Testing, Production and Postproduction activities
• Address operational matters by working with business units to identify system solution to operational issues
• Participate and advise in new business/operational initiatives
• Provide guidance on current and future system capabilities
• Identify areas of operational improvement, promote strategic relationships with business areas, vendor, governmental and partner organizations
• Work with provider reimbursement tools, collaborate with Claims Operations, Utilization Management, and Network Management to setup pricing methodologies
• Facilitate improvement of the payment transaction process by interacting with providers and finance team
• Manage project implementation of upgrades and new products as it relates to Core Systems

Minimum Qualifications

• Bachelor’s Degree from an accredited college or university.
• A minimum of 10 years of healthcare systems experience such as process improvement, project management or system configuration.
• Project Management and Staff Supervision a plus

Salary range is $150,000 to $165,000 with excellent benefits (Pension Plan)
#ZRCompany DescriptionRCM Health Care Services’ mission is to provide opportunities for qualified candidates across medical professions. We deliver timely results and have built a reputation of trust with our clients and candidates. Since 1975, we have been providing staffing solutions to many of the finest healthcare institutions across the nation and careers for thousands of candidates. As professional career opportunity matchmakers, we follow up and follow through to help our clients and candidates to reach their career and life goals. We proudly hold the Joint Commission Gold Seal of Approval as well.Company DescriptionRCM Health Care Services’ mission is to provide opportunities for qualified candidates across medical professions. We deliver timely results and have built a reputation of trust with our clients and candidates. Since 1975, we have been providing staffing solutions to many of the finest healthcare institutions across the nation and careers for thousands of candidates. As professional career opportunity matchmakers, we follow up and follow through to help our clients and candidates to reach their career and life goals. We proudly hold the Joint Commission Gold Seal of Approval as well.