Manager, Provider Configuration
About The Position
The Provider Configuration Supervisor is responsible for leading and overseeing all day-to-day provider and contract configuration activities within the claims adjudication system (EZCAP) for a fully delegated IPA/MSO operating under Full-Risk Medicare Advantage and Value-Based Care contracts. This role ensures that providers, facilities, contracts, fee schedules, DOFRs (Delegated Organization Financial Responsibility), benefit configurations, and claims payment rules are configured accurately, timely, and in alignment with executed contracts, delegation agreements, and financial models. The Supervisor leads configuration analysts, enforces configuration standards, mitigates downstream claims risk, and ensures claims are clean, payable, and audit-defensible. This is a mission-critical role: configuration errors directly result in incorrect provider payments, financial leakage, disputes, regulatory exposure, and provider dissatisfaction.
Requirements
- 6+ years of healthcare claims configuration experience in an IPA, MSO, or health plan.
- 3+ years of hands-on EZCAP configuration experience required.
- Deep experience in delegated, full-risk Medicare Advantage environments required.
- Proven experience configuring DOFRs, provider fee sets, and complex payment logic.
- Advanced EZCAP configuration knowledge:
- Provider builds
- Contract loading
- DOFR logic
- Fee schedules
- Strong understanding of:
- Medicare Advantage delegation models
- Claims adjudication workflows
- Provider payment methodologies
- Advanced Excel and analytical skills.
- Exceptional attention to detail
- Strong systems and financial logic thinking
- Ability to interpret contracts into executable system rules
- High accountability and ownership mindset
- Strong cross-functional communication
- Comfort operating in high-risk, audit-exposed environments
Nice To Haves
- 2+ years of supervisory or lead experience strongly preferred.
Responsibilities
- Claims System Configuration Leadership (EZCAP)
- DOFR & Financial Responsibility Configuration
- Provider Fee Set & Contract Configuration
- Team Leadership & Supervision
- Cross-Functional Coordination
- Claims Readiness & Issue Resolution
- Audit, Compliance & Delegation Readiness
- Change Management & Configuration Governance
- Reporting & Performance Oversight
Benefits
- Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
- Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
- Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
- Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.
- Career Development: Tuition reimbursement to support your education and growth.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
