Configuration Expert

Qualifications

• Knowledge in at least three of the areas under the purview of Med Policy Configuration: benefits, contracting, coding, fees schedules, or claim edits (CES)
• Knowledge of current managed care business practices and adjudication systems used by the Health Plan
• A working knowledge of the healthcare industry, preferably health insurance/managed care
• Collaboration, written and verbal communication, detailed analytical and organizational skills; ability to manage time with competing priorities; self-motivation; leadership; and ability to work independently with minimum supervision
• Additional required knowledge includes: claims processing, configuration of contracts, benefits, fee schedules, and Claims Editing System; ability to interpret business requirements into system coding edits, and testing of configuration builds

Responsibilities

• Configuration Analyst will be responsible for advanced system updates that impact multiple configuration pieces
• They will design configuration solutions to meet new business requirements and perform updates for benefits, coding, contracts, fee schedules, and claim editing rules in adherence with business policies and state requirements
• Analyze incoming requests and design configuration solutions to meet business requirements
• Perform configuration changes for coding, contracts, benefits, fee schedules, and claim editing rules as needed
• Collaborate with the Configuration Lead to ensure the solution meets/exceeds the configuration request
• Create testing scenarios to demonstrate the efficiency of proposed configuration solutions
• Maintain thorough and concise documentation for tracking of all contracts, benefit, fee schedule, and claim editing rule changes related to Change Control Management or issues for quality audit purposes
• Support claims staff with moderately complex claims issues
• Execute configuration changes in an accurate and timely manner to meet the department's standards for quality and turnaround times
• Collaborate with person development of configuration standards and best practices
• Identify claims impacted by configuration changes done in the system and send reports to the claims administration department for reprocessing

Full Description

Job Title: Sr. Configuration Analyst

About the Role:

The Sr. Configuration Analyst will be responsible for advanced system updates that impact multiple configuration pieces. They will design configuration solutions to meet new business requirements and perform updates for benefits, coding, contracts, fee schedules, and claim editing rules in adherence with business policies and state requirements.

Duties:

• Analyze incoming requests and design configuration solutions to meet business requirements.

• Perform configuration changes for coding, contracts, benefits, fee schedules, and claim editing rules as needed.

• Collaborate with the Configuration Lead to ensure the solution meets/exceeds the configuration request.

• Create testing scenarios to demonstrate the efficiency of proposed configuration solutions.

• Maintain thorough and concise documentation for tracking of all contracts, benefit, fee schedule, and claim editing rule changes related to Change Control Management or issues for quality audit purposes.

• Support claims staff with moderately complex claims issues.

• Execute configuration changes in an accurate and timely manner to meet the department's standards for quality and turnaround times.

• Collaborate with person development of configuration standards and best practices.

• Identify claims impacted by configuration changes done in the system and send reports to the claims administration department for reprocessing.

Requirements:

• Knowledge in at least three of the areas under the purview of Med Policy Configuration: benefits, contracting, coding, fees schedules, or claim edits (CES).

• Knowledge of current managed care business practices and adjudication systems used by the Health Plan.

• A working knowledge of the healthcare industry, preferably health insurance/managed care.

• Collaboration, written and verbal communication, detailed analytical and organizational skills; ability to manage time with competing priorities; self-motivation; leadership; and ability to work independently with minimum supervision.

• Additional required knowledge includes: claims processing, configuration of contracts, benefits, fee schedules, and Claims Editing System; ability to interpret business requirements into system coding edits, and testing of configuration builds.

• Two or more EPIC Tapestry certifications are strongly preferred.