Clinical Applications Administrator

Independent Health Association•Buffalo, NY

3d•$32 - $35

About The Position

The Clinical Applications Administrator shall be responsible for understanding the intersection of Nova’s business requirements and clinical platform system(s) capability. The Clinical Applications Administrator will be responsible for working with multiple departments, including Analytics, Client Service, Medical Management, IT, System Configuration, Customer Service, Claims, Enrollment, and Pharmacy, with focus on maximizing the clinical system to provide for various business operational needs and client-specific requirements. In addition, the Clinical Applications Administrator will work as a business partner with various other Nova project teams and clients to provide a better understanding of the capabilities of the system, workflows and associated business processes. The Clinical Applications Administrator will also provide data and analytical support for Nova’s Stewardship Model and Nova’s Health Plan Performance team. This position will provide strategic direction in the conception, establishment and system solution for client-specific cost driver mitigation efforts and strategies geared to improve health outcomes and engagement for Nova clients/members.

Requirements

High school or GED required
Four (4) years of business operations and/or business systems experience required.
Excellent verbal, written and interpersonal communications skills with emphasis on diplomacy, negotiation, persuasiveness and interaction with multiple levels of management.
Ability to lead or participate on multi-disciplinary project teams.
Proven examples of displaying the Nova values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Nice To Haves

Associates degree or higher, in computer science, information technology, or any other related technology discipline preferred.
Medical Management operations and/or system configuration experience strongly preferred.
Functional knowledge of benefit structures and applications, claims processing and financial systems, preferred.
Prior experience with clinical systems, core claims systems, telephone platforms, workforce management, and CRM applications is preferred.
Operational expertise sufficient to understand and successfully consult with business units and IT on capabilities of the applicable business systems.
Knowledge and experience in the development of departmental policies, processes, and procedures.
General knowledge and understanding of medical and procedure coding formats including but not limited to CPT, ICD-9, ICD-10, HCPC, REV and DRG is preferred.
Experience in the research, development, and implementation of clinical best practice, and analysis of outcome measures.

Responsibilities

Responsible for the administration, maintenance, development, configuration and testing of clinical systems, including extracts. Note: sometimes this accountability must be performed during non-traditional work hours.
Coordinate cross-functional implementation of software and upgrades; Functions as primary contact person during development and testing in applicable environments (Dev, Test, QA, Production). Note: sometimes this accountability must be performed during non-traditional work hours.
Participate on designated strategic and business critical projects.
Coordinate the development and implementation of integrated system business rules and work flow processes within applications and other enterprise systems to ensure consistent and effective data and process outcomes across the organization.
Coordinate the development of SOPs and System Operation’s Documentation for business owned processes and functions.
Provide clinical system expertise to clients and providers.
Act as a liaison between the clinical system vendor(s), IT, and the user communities of the clinical system supported.
Develop, manage, and communicate service level agreements and metrics related to the business systems.
Ensure service level agreements are met and that any adverse impact on service quality is kept to a minimum.
Report and track all open issues with IT and/or the vendor through resolution.
Provide daily monitoring and maintenance of business systems.
Translate business rules into analytical models and works as a liaison between technical owners and business owners to effectively implement processes and results.
Work with other members of the health plan performance management team and providers to develop and implement strategies for managing the health of member populations.
Develop reports to track and monitor programs within the clinical system.