Configuration Analyst (Clinical Systems)
The Configuration Analyst is responsible for the activities related to advanced system updates that can impact more than one piece of the configuration. New health plan implementations and conversions within Business Operations. Designs configurations solutions to meet new business requirements and performs updates for benefits, coding, contracts, fee schedules and claim editing rules in adherence with business policies and state requirements.
• Analyzes incoming requests and designs configuration solutions to meet business requirements.
• Performs configuration changes for coding, contracts, benefits, fee schedules and claim editing rules as needed.
• Collaborate with the Configuration Lead to ensure that they solution will meet/exceed the configuration request
• Creates testing scenarios to demonstrate efficiency of proposed configuration solutions.
• Maintains thorough and concise documentation for tracking of all contract, benefit, fee schedule and claim editing rule changes related to Change Control Management or issues for quality audit purposes.
• Supports claims staff with moderately complex claims issues.
• Executes configuration changes in an accurate and timely manner to meet the department’s standards for quality and turnaround times.
• Collaborates with person development of configuration standards and best practices.
• Identifies claims impacted by configuration changes done in the system and sends reports to the claims administration department for reprocessing.
Skills:
• 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.
• 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 strongly preferred.
Education:
Required – High School Diploma
Preferred- Bachelor’s Degree
Required- 4 years Managed care, claims processing, and/or configuration of benefits/contracts/fee schedules/medical policy payment rules.
