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About the role
- Clinical Applications Administrator managing clinical systems at Nova Healthcare. Responsible for integration with various departments and optimizing business operations.
Responsibilities
- Responsible for the administration, maintenance, development, configuration and testing of clinical systems, including extracts
- Coordinate cross-functional implementation of software and upgrades; Functions as primary contact person during development and testing in applicable environments (Dev, Test, QA, Production)
- Participate on designated strategic and business critical projects
- Coordinate the development and implementation of integrated system business rules and work flow processes within applications and other enterprise systems to ensure consistent and effective data and process outcomes across the organization
- Coordinate the development of SOPs and System Operation’s Documentation for business owned processes and functions
- Provide clinical system expertise to clients and providers
- Act as a liaison between the clinical system vendor(s), IT, and the user communities of the clinical system supported
- Develop, manage, and communicate service level agreements and metrics related to the business systems
- Ensure service level agreements are met and that any adverse impact on service quality is kept to a minimum
- Report and track all open issues with IT and/or the vendor through resolution
- Provide daily monitoring and maintenance of business systems
- Translate business rules into analytical models and work as a liaison between technical owners and business owners to effectively implement processes and results
- Work with other members of the health plan performance management team and providers to develop and implement strategies for managing the health of member populations
- Develop reports to track and monitor programs within the clinical system
Requirements
- High school or GED required
- Associates degree or higher in computer science, information technology, or any related technology discipline preferred
- Four (4) years of business operations and/or business systems experience required
- Medical Management operations and/or system configuration experience strongly preferred
- Functional knowledge of benefit structures and applications, claims processing and financial systems preferred
- Prior experience with clinical systems, core claims systems, telephone platforms, workforce management, and CRM applications is preferred
- Operational expertise sufficient to understand and successfully consult with business units and IT on capabilities of the applicable business systems
- General knowledge and understanding of medical and procedure coding formats including but not limited to CPT, ICD-9, ICD-10, HCPC, REV and DRG is preferred
- Experience in the research, development, and implementation of clinical best practice, and analysis of outcome measures
- Excellent verbal, written and interpersonal communications skills with emphasis on diplomacy, negotiation, persuasiveness and interaction with multiple levels of management
- Ability to lead or participate on multi-disciplinary project teams
- Proven examples of displaying Nova values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Benefits
- full range of benefits
- generous paid time off
- scorecard incentive
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