Senior Director of Core Systems

The Senior Director of Core Systems is responsible for evaluating operational processes and procedures for process improvement of MetroPlusHealth Core Applications. This position will work with our application vendors as well as Claims Operations, Utilization Management, Network Management, and other operational areas to optimize the use of core systems.

Scope of Role & Responsibilities

• Oversee development and implementation of short/long term business objectives
• Direct and support initiatives to focus on projects with plan wide benefit in accordance with corporate budgetary objectives
• Ensure continuous delivery of IT services through oversight of service level agreements and monitoring of IT systems vendor performance
• Oversee functions performed by delegated vendor as it relates to benefit configuration, claims processing, provider setup and account payable system
• Manage activities and communications between key business stakeholders and Core System Vendor for implementation of new systems and optimization of current systems
• Develop and oversee SDLC methodology, including business requirements creation and sign off, Quality Assurance, User Acceptance Testing, Production and Postproduction activities
• Address operational matters by working with business units to identify system solution to operational issues
• Participate and advise in new business/operational initiatives
• Provider guidance on current and future system capabilities
• Collaborate with operational areas and the system vendor to create system enhancement road map
• Identify areas of operational improvement, promote strategic relationships with business areas, vendor, governmental and partner organizations
• Work with claims editing vendors, Claims Operations, Utilization Management, and Network Management to set up system edits to increase medical cost savings
• Facilitate improvement of the payment transaction process by interacting with providers and finance team
• Manage project implementation of upgrades and new products as it relates to Core Systems
• Manage production processes, regulatory reports submission and provider directory activities
  
  
  

Required Education, Training & Professional Experience

• Bachelor’s Degree from an accredited college or university in Information Systems, Computer Science, Healthcare IT or related field
• A minimum of 10 years’ systems/operations management-related experience
• Healthcare IT experience required
• Project Management and Staff Supervision a plus
  
  
  

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