Claims Configuration and Audit Manager

Claims Configuration And Audit Manager

Hennepin Health is seeking a Claims Configuration and Audit Manager to join their team. This position will lead their team in accurately documenting claim related benefit configuration requirements supplied to the claims delegated vendor (FACETS claim adjudication system) for configuration. This position will also be responsible for the day-to-day claims-related backend audit activities required to ensure the claim delegated vendor is adjudicating claims according to the Provider and Minnesota Medicaid contracts. The manager of this team will supervise four senior business analysts and one principal business analyst that document both the benefit and provider contract business requirements, complete the necessary business acceptance testing, and complete the monthly and quarterly claims related audits including error correction and reconciliation, in addition to leading projects and participation in DHS related workgroups.

Current Hennepin County employees who refer a candidate hired into an open competitive position may be eligible for a $500 referral bonus. For more information visit employee referral program.

This position is hybrid and will be performed both on-site at 525 Portland Avenue, Minneapolis, MN 55415, and remote as job duties require. Work hours will be Monday through Friday from 8 a.m. to 4 : 30 p.m. While this position is designated as hybrid, based on current requirements hires must reside in or relocate to Minnesota or Wisconsin. New Employee Orientation (NEO) for all new benefit-earning employees is in-person in downtown Minneapolis. Details about NEO will be provided upon hire. This is a full-time, benefit-earning position. This position is internally classified as an Administrative Manager, Senior. You must attach a resume as part of your application materials to be considered for this position. In this position, you will :

• Manage the end-to-end business development of the benefit and provider contract configuration requirements process to ensure the health plan product benefits and provider contracts are implemented timely and accurately in collaboration with the claims delegated vendor.
• Manage the monthly and quarterly claims audit process including error correction, reconciliation, claims recovery; manage the annual claims accuracy audit in coordination with Hennepin County internal audit and the third-party audit firm.
• Develop and document new departmental business policy and procedures and update existing policy and procedures on an annual basis; ensure adherence to the policy procedures.
• Develop collaborative relationships across Hennepin Health (medical administration, finance, provider contracting, and provider data operations) to proactively address existing issues or new changes that impact the service delivery to our members and providers.
• Ensure quality assurance processes are followed and all approvals are obtained before configuration changes are moved into production.
• Manage, monitor, and troubleshoot all details of claim processing audit activities including root cause analysis, error correction and reconciliation processes, claims recovery projects.
• Supervise and manage direct reports including annual performance reviews, probationary reviews, individual development plans, conduct regularly scheduled development sessions, and conduct team meetings.
• Manage work assignments with staff until completion; support and adhere to issue management and change management processes.

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About the department : Hennepin Health provides health care coverage to Hennepin County residents who are enrolled in a Minnesota Health Care Program. Hennepin Health is a nonprofit, state-certified health maintenance organization that contracts with the Minnesota Department of Human Services. We envision being a leader in partnering with our members and communities to improve health, by integrating health care and service to enhance the health and well being of our members and the community.

About Hennepin County : Hennepin is the largest county government organization in Minnesota. Our employees work every day to improve the health, safety and quality of life for our residents and communities. All of our jobs align with our mission to serve residents through transformative services that eliminate disparities, eliminate inequities, and create opportunity for all and our vision of a community where all people are healthy, all people are valued, and all people thrive. Our employees receive a combination of competitive benefits and positive workplace culture not found at other organizations. This includes meaningful work that impacts our community, competitive pay, work-life balance, a variety of benefits and opportunities to grow. Learn more at The Bridge.