Job Description
**NOTE** this is NOT an IT role and it will be configuring our Facets claims payment operating platform
Providence is seeking a Associate Systems Administrator who will:
- Be responsible for healthcare configuration solutions within PHP’s core claims processing products (Facets, Networx, Optum Pricing, Optum CES).
- Understand how these products integrate with other PHP systems such as Care Advance, TCS, UPP, PIMS etc.
- Have broad understanding of health plan wide processes, including claims processing, medical/payment policies, product implementations, provider network development and contract management.
- Have ability to collaborate and communicate with our business partners is critical as we strive for alignment on intent, automation solutions and data accuracy.
- Do analysis and continuous optimization of system functionality with focus on root cause analysis to ensure we are implementing long term data fixes is also key.
- Work from high level functional analysis, detailed technical system configuration and support of business and management decisions.
Major Challenges Include:
- Ensuring all existing PHP provider and employer contracts and regulatory requirements are correctly and effectively administered.
- Ensuring new employer and provider contracts, benefits, and provider risk arrangements/financial incentives can be administered successfully prior to established deadlines.
- Maintaining a global understanding of the software functionality to accommodate the evolving Health Plans business needs.
- Prioritizing and managing the high volume of system configuration and maintenance tasks and understanding what constitutes a priority.
- Developing and administering effective audits to maintain system data integrity.
- Working with people who span a wide range of positions inside and outside the organization, sharing information with them as appropriate to facilitate work processes and management decision-making.
- Understanding and applying FACETS functionality to the ever-changing environment including consumer driven healthcare, and complex provider contracting requirements.
- Being able to present complex technical information and recommendations in a clear and concise manner and organize information to facilitate effective decision making.
In this position you will:
- Maintains an in-depth working knowledge of FACETS and integrated applications: understand the relationship between and implications of changes across applications as well as impacts to downstream reporting and vendors.
- Perform system configuration analysis, design, coding and unit testing for simple to medium complex customer specific solutions within Facets and integrated with Facets such as CES, Networx (and other Pricing software), UPP, PIMS. Evaluates proposed policy changes and impacts. Ensures correct administration and adherence to policies, procedures and regulatory guidelines.
- Perform feasibility review within the assigned discipline, key participant in product portfolio development, implementation of mandates, network development, software upgrades and operational workflow discussions.
- Optimizing and/or implementing new operational processes for continued efficiency.
- Trouble shooting problems and utilize appropriate resources for research and correction.
- Follows guidelines for documentation and resolution of issues within our internal change management system to support SLAs. Departmental reporting to assist with workload and SLAs.
- Performs audits as needed to ensure effective administration of health plan contracts and processes. Participate in audits as directed.
- Assists in developing and writing technical procedural documentation within the scope of knowledge.
- Maintaining project plans as related to implementation tasks.
Job Specific Knowledge, Skills and Abilities:
- In depth understanding of managed care transaction systems required.
- Understanding of strategic and tactical direction of Providence Health Plans.
- Ability to learn new software and concepts quickly.
- Proficient in Microsoft Office Suite to include Word, Excel, MS Access.
- Ability to create Facets MS Access database queries and/or SQL to support configuration analysis work. Comprehension of the Facets Data Dictionary and Data Model.
- Demonstrated excellent analytical, organizational and time management skills.
- Excellent interpersonal, persuasion and negotiation skills. Ability to work collaboratively with internal and external customers to help teams develop sound business decisions and requirements.
- Effective listening and critical thinking skills.
- Effective problem solving with attention to detail and high level of accuracy.
- Understand business rule logic for the functional area and high level business requirements for each product line, provider network etc.
- Knowledge of operational processes and core business functions within the Health Plan.
- Ability to help develop, interpret, and implement configuration for the assigned functional area (i.e.: Provider, Pricing and Benefits).
- Excellent written and verbal communication skills.
- Ability to manage multiple and constantly changing priorities.
Required qualification:
- 3 years of medical claims or relevant health insurance operations experience
Preferred qualifications:
- Bachelor’s Degree
- FACETS experience
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About the department you will serve.
Providence Strategic and Management Services provides a variety of functional and system support services for all eight regions of Providence from Alaska to California. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
About Us
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
About the Team
Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.
We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.
We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.