Develops, and implements standards, quality gates and governance frameworks.
Ensures that the core system configuration is executed with rigor, transparency, and precision.
Strengthens upstream quality and operational readiness by leading disciplined change processes, anticipating downstream impacts, and establishing a consistent framework that reduces defects, improves accuracy, and enhances the reliability of the claims environment.
Oversees the end-to-end configuration life cycle including analysis, requirements validation, design, build, testing, migration, and post-deployment monitoring.
Establishes standardized processes, documentation requirements, and quality gates to ensure accuracy, traceability, and reliable execution of configuration changes.
Ensures configuration solutions support accurate adjudication and align with operational needs, regulatory requirements, and enterprise readiness.
Collaborates with cross functional teams on configuration priorities, impacts, and implementation timelines.
Tracks and trends configuration errors, collaborating on remediation planning, systemic improvements, and prevention strategies.

Requirements

Bachelor's Degree
At least 7 years of experience in a system configuration or managed care operations
At least 5 years of experience leading, supervising and/or managing staff in technical or operational environments
Significant experience configuring benefits, pricing methodologies, provider payment logic, and related adjudication rules
Extensive knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD)-10, DRG/ Ambulatory Payment Classification (APC), and pricing methodologies
Advanced knowledge of and experience with American Health Information Management Association (AHIMA) coding standards
Knowledge of and experience with utilizing Systems Development Life Cycle (SDLC), configuration change management methodologies, testing protocols, document standards, and best practices
Experience supporting audits, corrective actions, and regulatory reviews.

Benefits

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills

system configurationmanaged care operationsbenefits configurationpricing methodologiesprovider payment logicadjudication rulesCurrent Procedural Terminology (CPT)Healthcare Common Procedure Coding System (HCPCS)International Classification of Diseases (ICD)-10Systems Development Life Cycle (SDLC)

Soft skills

leadershipsupervisioncollaborationchange managementanalytical thinkingproblem-solvingcommunicationorganizational skillsattention to detailstrategic planning

Certifications

Bachelor's DegreeAmerican Health Information Management Association (AHIMA) coding standards