Newsworthy

Position Overview

The Director of IT Core Applications is responsible for evaluating operation processes and procedures for process improvement of Core Applications. Will work with claims editing applications and vendors, Claims Operations, Utilization Management, and Network Management to setup system edits.

Job Description
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 setup system edit 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
Minimum Qualifications
Bachelor’s Degree from an accredited college or university in Information Systems, Computer Science, Healthcare IT or related field
A minimum of 15 years Data Processing related experience
Healthcare IT experience required
Project Management and Staff Supervision a plus
Professional Competencies

Integrity and Trust
Customer Focus
Functional/Technical skills
Written/Oral Communication