a. Lead, define, review and scrutinize all business requirements for system solutions monitors and maintains the integrity of the system infrastructure and acts as the subject matter expert SME for business and technical requirements.
b. Manage the system and operational processes for the Blue Distinction Total Care BDTC solution. Will analyze processes to provide support for internal and external customers regarding system and integration issues and make recommendations to minimize errors and reduce manual interventions in the process.
c. Define, analyze, plan, test, implement, maintain and document technology solutions that satisfy business objectives. Communicate and collaborate with stakeholders across the business in a timely manner and recommend file and/or system changes to minimize errors.
d. Coordinate and facilitate strong internal partnerships with Technology and vendor personnel, to ensure timing of all technical deliverables/projects e.g. modifications, interfaces, upgrades, conversions, etc.. Work directly with Technology and other stakeholders on all projects related to provider payment and payment policies. Support and cultivate department process improvement activities.
e. Daily oversight and relationship management with vendor contacts. Ensure accurate system integrations, adherence to Service Level Agreements, assurance of regulatory compliance and invoicing/reconciliations.
f. Manage multiple project initiatives with responsibility at different levels. Responsible for interfacing with stakeholders across Wellmark, and oversight for completion of tasks/goals completed by and with others.
g. In collaboration with Actuary and Business Analytics, responsible for developing, maintaining and monitoring BDTC rates.
h. Provide training and education to internal/external stakeholders. Serve as the Subject Matter Expert for technical and user requirements.
i. Demonstrate business knowledge for determining business requirements for the design of operational system upgrades and enhancements. Participate in system conversions and lead various upgrade components. Interact and partner with project/program managers to ensure active participation clarify understanding of high level business needs and requirements on complex projects.
j. Comply with regulatory standards, accreditation standards and internal guidelines remain current and consistent with the standards pertinent to Network Innovation.
k. Other duties as assigned.