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Title

Director of Implementation & Configuration 

Description

Peak TPA (Peak), a Tabula Rasa Healthcare company, helps PACE organizations manage the business functions that drive the major sources of reimbursement revenue and utilization costs. Peak provides services that optimize financial management and fulfill regulatory requirements for health plan functions. Peak is committed to the PACE model of care and thus to the success of the sponsoring organizations.

Peak TPA is seeking candidates to fill the role of Director of Implementation & Configuration.

This role may be based out of St. Louis, MO or Eden Prairie, MN. If candidates in these areas are not identified, we may consider remote work.

Summary: Under the direction of the Peak Chief Executive Officer (CEO), the Director of Implementation & Configuration leads, directs and manages all aspects of Peak’s processing systems and client implementations and trainings, and is responsible for oversite of the regulatory department. He/she will be responsible for ensuring clients are properly onboarded and Peak’s processing systems are configured to maximize automation and working efficiently, and that data is submitted to CMS and states as required for risk adjustment, encounter data, and all Medicare Part D components are submitted timely and accurately.

Essential Functions:

System Responsibilities

  • Lead the configuration of client’s rules, benefits, members, and providers in Peak’s system.
  • Oversee the submission and tracking of support tickets for Peak’s processing system.
  • Ensure policies, procedures and formal delegations are in place to maintain effective coordination and control of configuration, provider network, and regulatory department activities.
  • Ensure that service and product standards are in place and that programs and training is in place to assure consistent achievement of targets.
  • Regularly evaluate policies and procedures to ensure consistent application and effective operation.
  • Evaluate and ensure overall quality of service delivery process.
  • Recommend alternative strategies to improve effectiveness of operations.
  • Establish measures and processes by which to collect, monitor, evaluate, and report on key performance indicators.
  • Ensure the information and data integrity of the processing systems.
  • Continually increase the use of data as a basis for making business decisions.
  • Assist in the exploration and evaluation of in-house or purchased technology solutions for current and future business needs.
  • Instill and reinforce an outstanding service culture.
  • Take prompt and decisive corrective action when necessary to ensure achievement of financial, operational, quality and service goals.

Implementation of Client Services

  • Oversee the implementation of all services for clients.
  • Develop and maintain training materials for clients.
  • Conduct regional or other annual trainings for clients who have experienced turnover.
  • Facilitate user groups as needed.

Management support for business evolution and process improvement

  • Assist in the evaluation of department readiness and staff preparedness for business evolution and expansion.
  • Assist in the facilitation of process improvement projects identified, prioritized and assigned across the Peak organization.
  • Participate in all phases of project management to make certain that the objectives and are accomplished on time and within budget and that risks have been identified and properly mitigated.
  • Facilitate workgroups to identify ways to increase quality and efficiency and business and operations processes
  • Assure effective communication as organizational changes are implemented.

Talent Management

  • Collaborate with HR, parent company and Peak CEO to attract, develop and retain Peak talent.
  • Provide direct reports with timely and constructive performance feedback.
  • In accordance with company human resource policies and procedures, review, recommend or approve promotions and salary reviews.
  • Advise the management team on client issues.
  • Ensure all direct reports are fully informed of operational objectives.
  • Conduct regular meetings with direct reports and staff to communicate priorities and coordination of activities.
  • Support company-wide performance planning, coaching, appraisal and discipline programs to ensure consistent, fair, and transparent implementation and compliance with company policies and procedures.

Additional Functions:

  • Communicates clearly and concisely, with sensitivity to the needs of others
  • Maintains courteous, helpful and professional behavior on the job; displays a willingness and ability to be responsive in a warm and caring manner to all customer groups; consistently cooperates and supports organization in problem solving issues; ensures customer satisfaction by understanding and applying the Customer Service Policy, Procedure and Standards; will support the success of the entire team; establishes and maintains effective working relationships with co-workers
  • Follows all Policies and Procedures and HIPAA regulations
  • Maintains a safe working environment
  • Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
  • Establishes and maintains effective working relationships with co-workers

Supervisory Responsibility: Responsible for daily supervision of the Provider Network Specialists and Supervisor, Configuration Analysts and Regulatory team.

Travel: Periodic travel, 10-20%, depending on business needs.

 
Position Requirements

Knowledge, Skills and Abilities:

  • At least 10 years of Managed Care experience in leadership role.
  • MBA or equivalent business experience preferred.
  • Strong background in operations, financial management, IT and accounting.
  • Strong people skills
  • Outstanding, leadership, management and organizational skills
  • Capacity to oversee a complex operation, and the leadership skills to function as a mentor and coach.
  • Ability to budget and forecast demand, revenues and expenses and control costs.
  • Understand how to develop business plans and evaluate business trends to modify strategies.
  • Ability to set and meet high standards of service to develop a work force that embraces a culture of quality and service.
  • Ability to function effectively, exert influence and gain consensus at all organizational levels, in both direct, matrix and consultative organizational relationships, with internal stakeholders as well as external constituents.
  • Personal integrity and exemplary ethical standards.
  • Good personal time management skills and know how and when to impose deadlines and delegate tasks.
  • Creative, innovative, and entrepreneurial with good business acumen.
  • Tolerance for and the ability to perform in stressful and ambiguous situations.
  • The ability to interpret and administer policies and procedures consistently and objectively.
  • Outstanding communication skills with clarity of thought and the ability to express, advocate and defend views effectively both orally and in writing.
  • The flexibility and the ability to work in a relatively unstructured environment in an evolving, growing and dynamic company.
  • A forward thinking personality who can identify areas for improvement and take decisive and timely action to bring about the desired change.
  • The ability to attract, train, manage and motivate a skilled team.

Physical Demands & Requirements:

  • Communicate by way of the telephone with participants, customers, vendors and staff
  • Operate a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer
  • Remain stationary for extended periods of time
  • Occasionally exert up to 20 pounds of force to lift, carry, push, pull or move objects
  • Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
  • Occasional reaching to retrieve shelved items
  • Occasional bending/stooping

Work Environment:

  • This job operates in a professional or home office environment with a conversational noise level.
  • No substantial exposure to adverse environmental conditions is expected
  • Moderate pressure to meet scheduled appointments and deadlines
  • Potential for occasional verbal aggression by clients and vendors
 
Full-Time/Part-Time Full-Time  
Shift Days  
Position Director of Technology & Client Development  
Post Internal Days 0  
Number of Openings 1  
Location Peak Health Plan Management- St Louis, MO  
About the Organization  
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.  
Cell None Specified 

HoursPerWk None Specified 

supervisorUID None Specified 


This position is currently not accepting applications.

To search for an open position, please go to http://TabulaRasaHealthcareInc.appone.com



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