Responsible for the operations of one or more systems configuration units that are responsible for Analysis, Design, Build and Unit Testing of Provider Contracts and Benefits within the KPCC Platform, to ensure accurate and timely claims payment consistent with the Regional and National artifacts (e.g. contractual arrangement(s) made with the Providers, Employer Groups, etc.). Responsible for providing leadership, supervision and direction to employees. Directs the business systems configuration teams to meet operational, financial, and service requirements. Develops and executes strategic and operational business plans for the departments. Coordinates department operations and changes with other areas of the organization.
* Works on issues of broad scope.
* Receives assignments as objectives with the processes necessary to fulfill those goals.
* Requires considerable planning and direction setting.
* Develops and directs work schedules and monitors work flow to achieve established goals and objectives.
* Responsible for recommending changes in guidelines, procedures, and policies.
* Provides supervision to the HPSC Configuration Analyst Team responsible for Analysis, Design, Build and Unit Testing of Provider Contracts and Benefits within the KPCC Platform.
* Drives deliverables of the HPSC Team that leads the business requirements development and solution design process including creation of requirements and design documentation and facilitating sessions with business owners and other team members.
* Provides formal supervisory (hire, discipline ,performance management) responsibility and accountability for a team or department.
* Provides direction to employees following established using established guidelines, procedures and policies.
* Minimum three (3) years of experience in healthcare, managed care, insurance or equivalent environment.
* Bachelor's degree in health care, business, operations or related field OR four (4) years of experience in a directly related field.
* High School Diploma or General Education Development (GED) required.
License, Certification, Registration
* Two (2) years of experience in leading employees in business systems configuration or equivalent environment.
Certification in Tapestry modules in addition to
Core, AP and Benefits preferred
Experience with SQL Developer and Access
Demonstrated intermediate competency in medical
coding, medical terminology, claims processing, logical thinking and
understanding of relational database is required.
Knowledge of state and federal health plan
Knowledge of Kaiser Permanente internal process
Knowledge of BETS application is an added plus
Knowledge of Epic Tapestry modules
Advanced knowledge in healthcare benefits,
benefits administration and health care delivery from both payor & provider
perspective, EDI and paper claim lifecycle, along with health insurance
industry practices and standards.
Primary Location: California,Burbank,Marketing Sales Service and Admin 3100 Thornton Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Team Leader/Supervisor Job Category: Consulting Services / Project/Program Management (Non IT) Department: National BETS Administration Travel: Yes, 10 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
Click here for additional requirements >