Director, Facets Systems Configuration

posted on May 27, 2020

Location: Ohio

Job Description

Location: Ohio

Duration: Permanent

Responsibilities:

Licensure/Certification: Six Sigma certificate or Training preferred

Education / Experience:

  • Bachelor’s degree or equivalent years of relevant work experience is required
  • Master’s degree is preferred
  • A minimum of five (5) years of health plan business or systems solutions experience is required
  • Minimum of three (3) years of management experience is required
  • Facets experience is preferred

Required Competencies/Knowledge/Skills:

  • Proficient in Microsoft Office Suite to include Word, Excel, Access and Outlook
  • Familiarity of the healthcare field
  • High level of database and systems development knowledge
  • Ability to translate business requirements into technical specifications
  • Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision
  • Strong team and staff development skills
  • Strong collaboration and conflict resolution skill sets
  • Proven leadership with the ability to build relationships, collaborate and influence at all levels
  • Strong process and analytical skills with the ability to articulate and define outcome measures that capture key performance metrics
  • Strategic management skills
  • Resiliency in a changing environment
  • Strong decision making and problem-solving skills
  • Exceptional written and verbal communication skills with the ability to present information in a variety of different formats to all levels Strong interpersonal skills and high level of professionalism
  • Effective listening and critical thinking skills
  • Display a customer service orientation
  • Ability to develop, prioritize and accomplish goals
  • Excellent problem-solving skills with attention to detail

Role and Responsibility:

  • Lead the analysis, design, development, testing and implementation of the company’s Facets and clinical editing systems; provide application support during advanced stages of implementation
  • Direct and lead configuration activities of a highly technical team by providing coaching and mentoring with a focus on quality, efficiency and collaboration; provide guidance in resolving technical issues
  • Direct database configuration activities intended to modify and enhance the company operational database; activities include database set-up of product benefits, fee schedules, claims edits, provider agreements and claims processing rules
  • Lead automation and upgradation efforts for Facets and clinical editing systems
  • Responsible for proactive analysis of internal operational, service and performance metrics, and proactively initiate performance improvement activities across the organization to achieve service and satisfaction goals
  • Create technical design and provide technical oversight to ensure the proper architecture and product performance is delivered; create architectural design and technical design documents
  • Ensure appropriate approvals, testing, implementation controls and validation occur relative to new or modified records and files
  • Develop and maintain departmental policies, procedures and controls to ensure the integrity of the files, including HIPAA compliance
  • Initiate and implement automated solutions to ensure optimal data quality
  • Ensure that all policies and procedures are in place, are up to date, are consistent across department and CareSource and are compliant with all legal, Federal, State and Accrediting standards
  • Ensure compliance with Model Audit Rules, State, Federal and Accrediting Agencies for all elements related to systems configuration data and processes
  • Participate in national conferences and other events to stay current with industry changes
  • Provide direction in the development of best practices configuration strategies to meet corporate goals related to operational efficiencies and excellence
  • Work with business owners to achieve a system design that meets their needs and expectations
  • Ensure that supporting business processes and documentation exists as a basis for system logic
  • Play a consultative role with business owners around configuration, benefits, fee schedules, provider appeals related to claims, etc.
  • Perform any other job related instructions as requested

 

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