Cook Children's Healthcare Director, Contract Configuration - Cook Children's Health Plan in Fort Worth, Texas
Director, Contract Configuration - Cook Children's Health Plan
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Director, Contract Configuration directs a team accountable for the interpretation and implementation (including testing) of core contractual business requirements for CCHP system platforms. Core contractual business requirements include benefit plans and services, claims payment, provider set up and maintenance and prior authorization requirements. The position also will play a significant non-IT (Operations) leadership role in any new system platform implementations and system platform retirements. Education & Experience: • Bachelor's degree required • Minimum of 8+ years Health Care industry knowledge and operations (example: claims processing, enrollment, provider file maintenance) with ability to interpret and document business requirements. • Advanced problem solving, critical thinking, and process analysis skills to lead teams responsible for client configuration • Project management skills • Subject matter expertise to produce innovative solutions, and advance understanding of configuration best practices • Understands the healthcare industry, including competitors, the regulatory environment, and industry trends. • Knowledge of Texas Medicaid programs • Must have knowledge of CPT, ICD-9/ICD-10, HCPCS, Revenue Codes and pricing methodologies. • Benefit and fee schedule configuration experience. • Advanced knowledge of core processing systems in relation to configuration set-up. • Experience working with government agencies such as CMS, Medicaid, etc. along with interpreting agency and contract requirements. • Strong computer skills with proficiency in MS Word, Excel, Outlook, and Access, and Visio. PowerSTEPP and/or Tapestry claims system experience preferred. • Excellent communication skills both verbal and written. • Ability to participate in a team environment. • Self-starter who requires minimal supervision.
Cook Children's is an EOE/AA - Minority/Females/Disability/Vet