Virginia Premier Health Plan Director, QNXT Operational Support in Richmond, Virginia

About Us

Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.

By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.

At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.

If this sounds like you, read on!

Overview

The Director of the QNXT Operational Support Team manages the personnel responsible for the daily support of the QNXT platform for established lines of business. This includes the ongoing maintenance of the system such as the timely and accurate loading of Fee Schedules, various Reference Tables, etc. and being the first line of support for any Change Gear Tickets. The Director also provides support to QNXT Environment Management and Testing Team ensuring that all CTS tickets are being worked in a timely manner, code deployments are managed and all QNXT environments are operating efficiently, verifying that all testing is being conducted or coordinated appropriately with business teams/leads and in accordance with Testing Plans. Lastly, the Director is responsible for the oversight and maintenance of the benefit grids for all established lines of business on the system.

Responsibilities

  • Ensures teams are educated on the benefits and configuration of all lines of business needed to provide support

  • Works with the business to create business requirement documents for system configuration

  • Set the standard for how system documentation will be managed, maintained and utilized by the team

  • Partner with IT Support staff and Configuration team to understand the interface with Third Party Applications

  • Facilitate cross-functional team meetings

  • Work with organizational leadership in understanding the configuration and design of all new lines of business to establish the appropriate support model and impacts to system maintenance processes

  • Provide executive level status updates

  • Oversee the development of team metrics to measure performance

  • Stay connected to other QNXT Users and collaborate on shared initiatives

  • Stay abreast of QNXT upgrades and enhancements to functionality to serve as a liaison to the business units in the use of new functionality

  • Oversee the Quality Assurance and Testing of system configuration to ensure that the system is performing within acceptable levels established by business operations

  • Serve as resident QNXT business liaison in understanding and communicating system capabilities

  • Ensure all testing is being accomplished within the appropriate time tables and risks and issues are being reported timely

  • Ensure that all QNXT Environments are operating to specifications

  • Ensure that all Benefit Grids are maintained, approved and shared with the business as needed

  • Manage employee time, conduct performance appraisals, coach and encourage employees to achieve top performance

  • Partner with Human Resources to develop training material and training plans to ensure staff skills are sufficient to perform their job duties

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor’s degree in Computer Science, Information Systems, Healthcare Administration or related field

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Working knowledge of managed Medicaid, Medicare claims payment methodologies

  • In depth knowledge of medical field to translate medical policy, DMAS policy or CMS policy into stated benefit logic to be communicated for system configuration

  • Proven knowledge of Medicare (Part A&B) and Medicaid programs; preferred

  • Familiar with CMS and state regulatory guidelines related to claim processing and other Federal requirements; preferred

  • Proven work experience in creating and overseeing testing plans

  • Familiarity with TriZetto QNXT, FACETS or other Claim Processing Platforms

  • Ability to comprehend and interpret provider contracts, regulatory payment methodologies and develop appropriate action plans

  • Past experience with various automated testing software helpful

  • In depth knowledge of CPT, ICD-10, HCPS and other coding terminology

  • Proficient knowledge of Microsoft Office (Access & Excel)

  • Excellent interpersonal skills, including the ability to work with all levels of personnel including, but not limited to direct reports, peers and senior management personnel

  • Excellent written and oral communication skills

WORK BACKGROUND /EXPERIENCE

  • Minimum of 5 years working in the healthcare environment, Provider Billing Office, Hospital Billing or a Health Plan

  • Minimum of 5 years of experience in business process re-engineering or system configuration

  • Minimum 3 years of management experience, preferably in a technology or healthcare environment

  • Proven knowledge and ability to partner with senior management of key initiatives

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

Our mission is to inspire healthy living within the communities we serve!

Job ID 2018-5396

As an equal opportunity employer, Virginia Premier is committed to a diverse workforce. To ensure non-discrimination and affirmative action for individuals protected by Executive Order 11246, as amended, Section 503 of the Rehabilitation Act of 1973, as amended, the Vietnam Veterans’ Readjustment Act of 1974, as amended, and Title I of the Americans with Disabilities Act of 1990, as amended, Virginia Premier will consider applicants for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. Applicants who require accommodation in the job application process may contact Recruitment at 804-819-5151 for assistance. It is the policy of Virginia Premier Health Plan, Inc., to comply with the requirements of the Drug-Free Workplace Act of 1988. It is a violation of our drug-free workplace policy to use, possess, sell, trade, and/or offer for sale alcohol, illegal drugs or intoxicants in our workplace. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. Virginia Premier participates in E-verify.