Senior Manager Project Management ID-6974

January 14, 2025

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Job Description:

The Senior Manager Project Management Contract Platforms position performs and oversees multiple functions.

Primary responsibility is to oversee a team responsible for researching and analyzing Strategic pricing system functionality & enhancements. It also requires delineation of any other interfacing or manual manipulation altering the price. Validation of theory, when claim reports are furnished from other business areas.

They will also support the analysis of Aetna’s contract rate tools to identify operational improvement opportunities/validate a financial comment is needed, including walk through of the entry guidance when changes are warranted. The candidate must think critically, applying mastery pricing concepts to predict pricing outcomes.

This role will also provide project support which entails assessing risks both up & down stream, formulating business requirements, working in partnership with our IT counterparts, assembling testing strategies, validating testing results, including review and sign-off during code implementation. This role also includes formulation of training techniques, creation of the materials, and facilitation in partnership with other systems.

The candidate will also contribute to maintenance/ update all team training materials, including formulation of contract/claim examples, system mock-ups, and depiction of pricing outcomes. Candidate must be able to explain complex concepts in laymen's terms, as well as furnish visual representations of the concepts.

Standard Service Grouping Maintenance- at least on a quarterly basis, coordinate with various service grouping content owners, analyze code sets, implement maintenance requests, then audit for accuracy. All Service Grouping code updates will ideally be completed prior the new service code's effective date. Candidate will coordinate with business partners, including Provider Advance notification when off cycle code changes will be implemented.

Required Qualifications:

10+ years claim processing experience required
Full understanding of the SCM rate wizard input, non-preferred contracting options, Carve out & grouper tabs.
Familiar with Professional Component concept, and EPDB limitations related to same
Moderate understanding of EPDB & SCSR: Provider & PBG selection logic; fee schedule & modifier pricing logic
Demonstrated strong understanding of Strategic Pricer logic and concepts
Excellent verbal and written communication skills

Preferred Qualifications:

BIR/ Provider Solutions background
Network Contracting and/or SCM Contracting support experience
Familiarity with the various CMS payment methodologies supported by Strategic Pricer via Burgess software
QuickBase user experience

Education :

Bachelor's degree preferred/specialized training/relevant professional qualification.