HealthRules Payer Sr. Project Manager- Health Insurance

Overview

Remote With Possible Future Travel Full-time. Projé, Inc. is a woman-owned consulting firm providing advisory consulting services, project management, and analytical business resources in the health care industry. As a trusted advisor, Projé provides the knowledge, skills, and leadership to help clients achieve their goals. Projé offers a strong team-centered culture, focused on meeting project deliverables with excellence.

Responsibilities

• Uses program and project management experience, training, and skills to run successful projects within a Health Insurance Organization, specifically a HealthRules Payer claims system Implementation/Migration.
• Proven Expertise in HealthRules Payer and the functional areas within a health insurance organization, including enrollment, billing, claims, finance, provider, benefits, and medical management (GuidingCare).
• Engages with multiple stakeholders at all levels of the organization, including executives, directors, managers, and individual contributors.
• Ensures that the business teams integrate their designs so that functional areas do not make design decisions in a silo and that any crossfunctional impacts are coordinated.
• Coordinates the global design with the vendor to ensure that business needs are viewed in whole rather than at a functional level only.
• Coordinates crossfunctional UAT and E2E testing needs and ensures that the end-to-end business processes are tested appropriately.
• Provides configuration expertise for HealthRules Payer, and on-the-job guidance and training for other project staff.
• Responsible for managing configuration alignment across areas to support a complete and cohesive solution.
• Ensures that configuration methodology is followed and documentation is maintained.
• Leads configuration change control processes.
• Provides strategic advice to the Program Delivery Team.
• Owns and manages the program Functional teams.
• Ensures that overall business needs are addressed as related to the scope.
• Ensures deliverables are on track and escalates any project-related issues.
• With Domain Functional Leads, ensures that issues and risks are managed and mitigated.
• Alerts Program Delivery Team of significant potential program risks and makes recommendations concerning risk mitigation, scope change, and other key issues.
• Participates in the Change Control process within the Functional Domain.
• Responsible for functional requirement traceability between requirements gathered, design documents, workflows, and the configuration workbook.
• Develops and manages a project schedule throughout the project life cycle, from initiation through post-implementation.
• Applies formal Change Management processes when substantive modifications affecting the project scope, timeline, or resources/budget are suggested or necessary.
• Ensures the project team provides high-quality and cost-effective analytical support services.
• Facilitates and/or leads process improvement discussions and ensures that current state, desired state, and gaps are well documented for the development of recommendations.
• Facilitates issue resolution through analysis and collaboration; develops and presents recommendations to leadership and negotiates to reach a resolution.
• Support post-implementation stabilization and project closure activities.

Key Qualifications

• Must have hands-on experience in the HealthRules Payer claims system and understand the configuration of that system.
• Prior experience with a HealthRules Payer and GuidingCare Implementation or conversion required.
• Proven success in multiple project implementations within a health insurance company in claims, billing, provider, enrollment, benefits, and medical management (GuidingCare), etc.
• Ability to manage functional leads and functional domain areas in a large enterprise project.
• Demonstrated strong expertise in HealthRules Payer configuration, while providing hands-on guidance and training to project team members.
• Able to understand and impartially consider project needs among diverse colleagues in various departments of the same organization.
• Ability to produce accurate and precise work, detect and resolve discrepancies all while meeting deadlines.
• History of exemplary relationship management and effective communication with project sponsor, leaders, and team members from across the healthcare organization.
• Proficiency with MS Office Suite (Outlook, Word, Excel, PowerPoint), MS Project, and Visio required. Proficiency with SharePoint, Access, and SQL preferred.
• Familiarity with various project methodologies (Waterfall, Agile, SaFe, Hybrid).

Perks

• Competitive pay and bonuses
• Excellent benefits (medical, dental, vision)
• 401K with percentage company match
• Paid holidays and vacation days
• Flexible schedule

Education and Experience

• Bachelor’s degree in healthcare administration or related field. Four (4) years of experience managing projects within a health care organization may be considered in lieu of a bachelor’s degree.
• Hands-on experience with HealthRules Payer across key functional areas, including enrollment, claims, billing, finance, provider management, medical management, and benefits.
• At least five (5) years of experience working within a medical health care (insurance) organization.
• Three (3) years of experience managing one or more phases of a small to medium-sized project involving a minimum of five (5) cross-functional team members in a matrixed health care organization or closely related industry.
• PMP, PgMP, Scrum Master, Six Sigma Belt certification preferred.

We get projects done and help people along the way. We work with Payers and providers to manage, implement, test, and deploy systems that provide increased efficiency, process improvements, and high-quality outcomes. We are committed to achieving project deliverables and take pride in our clients’ success. Since our founding in 2004, Projé has built a stellar reputation of excellence through the dedication and commitment of our expert consultants who live out Projé’s mission every day.