Job Category : Claims

Requisition Number : DIREC006981

Posted: March 12, 2025

Job Type: Full-Time

Locations

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SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 285,000 members in California, Arizona, Nevada, and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare.

The Job

Captures and defines requirements to create, validate, analyze, monitor, and maintain critical reports for key department metrics. Responsible for continuous quality improvement of Configuration software applications, including management and oversight of system administration maintenance activities including system/user error reporting/tracking through resolution, enhancement testing validation through implementation, coordination of manufacture upgrades/releases with SCAN IT support, and replacement software selection.

You Will

Direct the daily operations of programs and applications for a team of 9-10 configuration resources, including oversight of program and system activities, hiring and training of staff, staff evaluation including competency assessment and program audits, performance appraisals, and regulatory and operational reporting.

Initiate and review program and application metrics for productivity and efficacy in support of the organization’s mission and goals. Track and trend activities and outcomes to identify opportunities to improve service, quality of care, and program efficiency.

Assure that the configuration team has standard Policy and Procedures, desktop procedures, training materials, and program communications that are current and accurately reflect the processes and regulatory requirements.

Ensure that configuration applications meet both current and future needs in support of organizational initiatives.

Provide central program and application ownership by representing the interests of and acting as subject matter expert regarding configuration programs and applications at internal committees as needed, such as Quality Committees, Information Technology Governance Committee, and Strategic and Operational Project Workgroups. Achieve financial objectives by preparing an annual budget, approving appropriate expenditures, analyzing variances, and initiating corrective action.

Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.

Promote compliance with and adhere to all regulatory and quality standards including but not limited to: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies’ standards such as the National Committee for Quality Assurance (NCQA) as it relates to the Performance Management and Clinical Systems activities.

Actively support the achievement of SCAN’s Vision and Goals.

Other duties as assigned.

Your Qualifications

• 8 years of experience in Enterprise Configuration preferably in a Managed Health Care setting, Medicare/Medicaid
• 5 years of leadership experience
• Basic knowledge of related NCQA standards, CMS and DHS regulations
• Understanding of System Development Life Cycle
• Strong healthcare program development, quality and analysis skills including understanding of basic research methods, and ability to make decisions accordingly
• Excellent presentation skills; group motivation and supervisory skills
• Strong strategic planning, critical thinking, and leadership skills
• Strong verbal and written communication skills
• Must have industry certifications such as the Certified Medical Reimbursement Specialist (CMRS) certification from American Medical Billing Association (AMBA).
• Graduate or Advanced Degree in Healthcare or human service-related field, or RN with bachelor’s degree. Equivalent experience will also be considered.

What's in it for you?

• Base Pay Range: $147,900.00 to $236,600.00 annually
• Work Mode: Mostly Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO) along with 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.