Configuration Manager- Plexis

Company Overview: Health Network One (HN1) partners with health plans and providers to modernize how specialty care is delivered and managed, reducing complexity, driving better performance, and improving lives.

With over 30 years of experience, Health Network One advances care in several unique specialties: Total Eye, Sleep Well, Pure Derm and Thrive Therapy. By curating specialty networks and credentialing providers who meet rigorous access and quality standards, we bring together value-based models and clinical expertise to ensure providers thrive, payers succeed, and members receive the high-quality care they deserve.

Position Summary: We are seeking a highly skilled Configuration Manager with deep expertise in the Plexis system and a strong background in specialty managed care. This role is essential to ensuring accurate and efficient configuration of benefits within our systems, supporting operational excellence.

Key Responsibilities

• Lead the configuration and ongoing maintenance of benefit plans within the Plexis platform, ensuring accuracy, compliance, and alignment with plan designs.
• Collaborate cross-functionally with Claims, Provider Administration, IT, and Clinical Operations to support benefit implementation, updates, and issue resolution.
• Serve as the subject matter expert on Plexis configuration capabilities, limitations, and optimization opportunities.
• Translate complex benefit documentation into system configuration requirements.
• Manage configuration projects related to new product launches, expansions, and regulatory changes.
• Conduct audits and quality checks to ensure benefit setups are functioning as intended.
• Oversee the maintenance and regular updates of key reference tables (including RBRVS, NCCI, Optum, Interest, and other regulatory or industry-standard tables) within the Plexis platform to ensure accurate claims adjudication and compliance.
• Manage the configuration, implementation, and ongoing updates of fee schedules, ensuring alignment with contractual, regulatory, and operational requirements.
• Monitor industry changes and regulatory updates impacting table structures and fee schedules, coordinating timely system updates and stakeholder communication.
• Collaborate with Claims, Provider Relations, and IT teams to resolve table-related issues and optimize table configuration for operational efficiency.
• Provide training and support to internal teams on Plexis functionality and configuration processes.
• Identify and implement process improvements to enhance efficiency and reduce errors.

Qualifications:

• Bachelor’s degree in healthcare administration, business, or related field (or equivalent experience).
• Minimum of 5 years of experience in benefit configuration within a managed care organization.
• Extensive hands-on experience with the Plexis system is required.
• Background in specialty benefit administration strongly preferred.
• Strong analytical and problem-solving skills with high attention to detail.
• Excellent communication, collaboration, and project management skills.
• Ability to work independently and manage multiple priorities in a dynamic environment.

Preferred Skills:

• Familiarity with Medicaid and Medicare managed care regulations.
• Experience with system implementations or migrations involving Plexis.
• Process improvement certifications (e.g., Lean, Six Sigma) are a plus.

Location:

Remote Position.