Evolent Health Director, Configuration in Arlington, Virginia
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Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving power that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign's Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by Parity.org; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
We are looking for bright and energetic people to join the Configuration Team in Health Plan Services. If you have a penchant for detail, have prior pricing and benefit configuration and leadership experience, we would like to talk with you!
This position is accountable for directing configuration managers that implement, promote and maintain the core administrative system configuration for Health Plan Services Clients. This role will focus on continuing to enhance the vision, value proposition, services for the configuration function and develop and align the staff in place to deliver against these services. Additionally, this role will work in concert with executive management and the Implementation Team and Operations Teams to deliver strategic objectives, and initiatives. This role will report to the Vice President of Configuration.
What You’ll Be Doing:
- Provide management and guidance to the system configuration managers who are
Responsible for overseeing the development of configuration builds, including benefit and payment rules, provider reimbursement and structures, and system parameters that accurately process and pay claims as specified in client contracts.
Define and ensure departmental and corporate goals related to client service levels agreements are met.
Work with senior management to define departmental vision and strategy.
Guide team efforts for defining processes, workflows, methods, tools, training and expected outputs to support configuration best practices.
Provide recommendations on development and design of new system logic to support legislative activity, medical policy changes, and reimbursement methodology changes.
Be a dynamic participant in quality assurance activities to promote traceability, accountability and adherence to standards and best practices for configuration in a multi-instance model within production teams.
Coordinate identification, prioritization and resolution of issues with various business areas and vendors that impact production and quality.
Develop tactical plans to improve processes and systems.
Assist in completing projects related to increased efficiencies, productivity, and quality for the Configuration function.
Act as a contributor to establish and meet short and long-term department goals consistent with company objectives and division strategy.
Work with executive management and human resources to evaluate role definition, levels, and career paths.
Recruit and hire top talent
Evaluate and align staff against target operating model, roles, and career paths.
Provide clear and consistent expectations to support management and staff around roles and levels to better assess employee placements and inform career path progression.
Expand employees' abilities by mentoring, coaching and developing top talent. Coordinate the training and development of direct staff including the competency assessment process. Act as the mentor and advocate of training and career development processes for assigned staff.
Guide the team on development of new methods and tools to advance efficiency and standards for maintenance of configuration. Utilizes personal subject matter expertise to produce innovative solutions for clients and the enterprise.
Foster a trusting and safe environment with an emphasis on problem solving and continuous improvement
The Experience You’ll Need:
Bachelor ’s degree preferred.
Extensive work in health insurance claims processing and system configuration, pricing configuration experience preferred
HMO Claims, managed care and Medicaid is great
In-depth knowledge of medical billing and coding
Excellent interpersonal, oral and written communication skills
Strong attention to detail and organization
Advanced skill level of Microsoft Office Suite (Excel, Word, Power Point)
Advanced problem solving, critical thinking, and process analysis skills to lead teams responsible for client configuration
Understanding of the healthcare industry, including competitors, the regulatory environment, and industry trends
Ability to provide strategic leadership and demonstrate the ability to develop future-state scenarios, create a vision for the future, defines factors needed to achieve success, and key actions required
Demonstrated leadership skills having ledconfiguration activity or function, knowledgeable about configuration best practices, methodologies and tools
Currently, Evolent employees work remotely temporarily due to COVID-19. As such we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.