Team Lead, Configuration Testing (Facets and SQL experience must)

CareSource Management Group Company

Job Overview

Location

Remote

Job Type

Full-time

Full Job Description

📋 Description

• As the Team Lead for Configuration Testing at CareSource, you will be at the forefront of ensuring the accuracy and integrity of our health plan's core systems. This pivotal role involves overseeing the day-to-day testing activities related to critical components such as medical benefits, provider reimbursement structures, member and provider correspondence, and the intricate claims processing workflow. Your expertise will directly impact the efficiency and reliability of our operations, ensuring that our systems accurately reflect policy requirements and contractual obligations.
• You will be instrumental in guiding and directing your team to successfully complete daily tasks, fostering an environment of high performance and continuous improvement. A significant part of your responsibility will include the onboarding, comprehensive training, and ongoing professional development of your team members, nurturing their skills and ensuring they are equipped to handle complex testing scenarios.
• A key aspect of this leadership position is the ability to prioritize all incoming work, requests, and activities. You will be expected to proactively identify areas of significant resource contention and provide well-reasoned recommendations for resolution to management, ensuring optimal resource allocation and project timelines are met.
• You will meticulously track issues and monitor status updates, ensuring proper follow-up and coordination with various business areas. Your role will involve not just identifying problems but also collaborating to provide effective solutions, minimizing disruptions and ensuring smooth system operations.
• You will be responsible for updating project documentation related to configuration and coordinating any necessary changes with your manager. This includes ensuring that all configuration changes are aligned with project goals and business requirements.
• A crucial part of your role will be to provide management with clear and concise ticket dashboards, offering insights into testing progress and potential bottlenecks. You will be tasked with identifying the root cause of recurring issues and developing proactive resolution strategies to reduce the volume of tickets in the future, thereby enhancing system stability and user satisfaction.
• You will ensure that all ticket controls, communication protocols, and approval processes are strictly followed prior to any system implementation, safeguarding the integrity of our production environment.
• You will maintain and support the accuracy and consistency of fee schedules and reimbursement methodologies, ensuring they align with required industry standards and regulatory compliance.
• This role includes providing oversight to vendor management tasks conducted by your team members. You will ensure that vendor responses are timely and that issues are resolved efficiently, maintaining strong relationships with our external partners.
• You will assist in auditing system configurations to guarantee accuracy and verify that internal controls are robustly in place. This is critical for minimizing potential fraud and abuse, mitigating business risks, and ensuring compliance with all relevant regulations.
• Your responsibilities will extend to performing any other job duties as requested, demonstrating flexibility and a commitment to supporting the broader team and organizational objectives. This includes staying abreast of industry best practices and emerging trends in configuration testing and health plan operations.
• The ideal candidate will possess advanced computer skills and a deep understanding of systems like Facets or similar health plan processing systems. Proficiency in medical terminology and advanced knowledge of the Microsoft Suite, particularly Word, Excel, and Access, are essential for success in this role.
• You will leverage your high-level programming and systems development knowledge to analyze complex configurations and identify areas for improvement. Your ability to effectively identify business problems, assess proposed solutions, and understand the needs of business partners will be paramount.
• A demonstrated ability to successfully define a portfolio of initiatives, including gathering business requirements, defining and prioritizing them, scoping projects, determining staffing needs, managing application configuration, developing testing approaches, overseeing training and documentation, establishing reporting strategies, and managing change processes, is expected.
• Knowledge of regulatory reporting and compliance requirements within the healthcare industry is crucial. You will need excellent listening and critical thinking skills to effectively diagnose issues and develop solutions.
• Strong problem-solving skills with a keen attention to detail are necessary to ensure the accuracy and completeness of testing efforts. Excellent written and verbal communication skills are vital for collaborating with team members, stakeholders, and management.
• You must be able to work independently and as part of a team, demonstrating strong interpersonal skills and a high level of professionalism. The ability to develop, prioritize, and accomplish goals effectively will be key to your success in this dynamic role.
• You will also utilize your proper medical coding knowledge and claims processing skills to validate system configurations and ensure adherence to industry standards.

🎯 Requirements

• Bachelor's Degree or equivalent years of relevant work experience.
• Minimum of three (3) years of health plan business or systems solutions experience.
• Advanced computer skills and proficiency in Facets or similar health plan processing systems.
• Demonstrated experience with SQL for data analysis and validation.

🏖️ Benefits

• Competitive salary range ($83,000.00 - $132,800.00) commensurate with experience.
• Potential for a bonus tied to company and individual performance.
• Comprehensive total rewards package invested in employee well-being.

Skills & Technologies

Senior

Remote

Degree Required

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CareSource Management Group Company

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About CareSource Management Group Company

CareSource is a nonprofit, multi-state managed care organization headquartered in Dayton, Ohio. Founded in 1989, it administers Medicaid, Medicare Advantage, and Marketplace health plans serving over two million members in Ohio, Kentucky, Indiana, West Virginia, and Georgia. The company focuses on improving health outcomes for low-income and vulnerable populations through integrated care management, behavioral health services, and social determinants programs.

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