Job Description

We’re searching for a Configuration Analyst, someone who works well in a fast-paced setting. In this position you will be responsible for the activities related to system updates, new health plan implementations and conversions within Business Operations. Designs configurations solutions to meet new business requirements and performs updates for either benefits, coding, contracts, fee schedules or claim editing rules in adherence with business policies and state requirements.

Think you’ve got what it takes?

Job Duties & Responsibilities

• Performs daily configuration changes in claim adjudication systems.
• 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.
• Creates testing scenarios to demonstrate efficiency of proposed configuration solutions.
• Maintains 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.
• Executes configuration changes in an accurate and timely manner to meet the department’s standards for quality and service level agreements.
• Assists with the 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.
• Monitors pended claims and work queues to update appropriate systems. Responsible for escalating identified issues, making recommendations, and assisting with implementing configuration changes to improve accuracy and efficiency of processes.
• Handles fluctuating volumes of work and prioritizes work to meet deadlines and user needs of the Health Plan.
• Performs system configuration design analysis associated with projects.
• Analyzes configuration errors and identifies required modifications.

• Supports new system implementations and upgrades.

Skills & Requirements

• Required H.S. Diploma or GED with a preferred bachelor's degree
• Required 2 years Managed care, claims processing, and/or configuration of benefits/contracts/fee schedules/medical policy payment rules
• A bachelor's degree may substitute for the required work experience
• Preferred Skill- Epic Tapestry configuration experience.