Sentara Healthcare is currently seeking a *remote, full-time Manager, Operations Support and System Administration for Virginia Premier Health Plan-Richmond, VA.
The Operations Support/Systems Administration manager manages all activities involving system benefit development and implementation, contract administration, coding compliance, fee schedule implementation, provider network database management and quality assurance, internal and external auditing of the key processes, system compliance and acceptance testing, and process improvements designed to increase operational effectiveness.
The manager will work collaboratively with Configuration Teams and across the organization to address payment discrepancies, determine configuration changes needed and how the changes impact other areas. The manager will troubleshoot claims system related issues and should be proficient in analyzing business needs, claims and system configuration (Contract, Benefit, Provider). This team will coordinate resolution of configuration and claims with appropriate areas. The manager serves as a POC for the Configuration Teams for DMAS and provider escalated claim payment issues.
- Bachelor's Degree Required
- 3 years related experience in Health Insurance or Information System Support required.
Strongly preferred Experience:
- Intermediate experience in writing SQL queries
- Knowledge of Health Claims processing
- Experience configuring Health Claims Systems for Benefits, Contracts for Government Programs (Medicaid and Medicare) or Commercial Plans
- QNXT experience a plus!
*Candidates must have a current residence in one of the follow states or being willing to relocate: FL, GA, IN, MD, NV, SC, NC, SD, TN, TX, WA, VA, WV, WI
Sentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier. Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. With more than 30 years’ experience in the insurance business and 20 years’ experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services – all to help our members improve their health.
Job Type: Full-time
Pay: $84,717.36 - $107,168.88 per year
Work Location: Remote