Senior Manager, Business & Systems Operations

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Identify, manage, and oversee both system and business requirements for both new and existing operations.

• Ensure that performance aligns with health plan, state, and provider contract specifications.

• Supervise system developments for new markets and products, which includes configuration and testing.

• Monitor and assess system performance trends while pinpointing opportunities for enhancement.

• Ensure that reporting deliverables are completed accurately and on time.

• Establish and manage business specifications pertinent to the authorization and claims/encounters system infrastructure.

• Identify and implement process enhancements across new business implementations, claims, encounters, auto adjudication, benefit specification testing, and system integrity.

• Initiate and oversee special projects aimed at boosting organizational efficiency, productivity, and accuracy.

• Manage the design and upkeep of market provider contract rate exhibits along with the configuration and testing of negotiated contracts.

⛳️ Requirements

• Must possess authorization to work in the U.S. without requiring employment-based visa sponsorship now or in the future.

• Bachelor's degree in a relevant field or equivalent professional experience.

• A minimum of 6 years in health care operations, system administration, product/program management, or claims administration.

• Familiarity with Medicaid and Medicare coding is required.

• Experience in benefit design is essential.

• Knowledge of reimbursement strategies and methodologies is necessary.

• Prior management experience, which includes hiring, training, assigning tasks, and evaluating staff performance.

• Experience in contracting and provider data management is preferred.

• A Master's degree is preferred.

🏝️ Benefits

• Competitive compensation.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentives may be included in the overall compensation package.

• Commitment to equal opportunity and diversity.