Job DescriptionIn this position you will be 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.
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.
- 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 contracts, 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.
- Performs peer reviews and testing of configuration changes done in the lower environments to confirm accuracy before changes are deployed in the production environment.
- 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 multiple areas of configuration with one project.
- Analyzes configuration errors and identifies required modifications.
- Supports new system implementations and upgrades.
Skills & Requirements- Required H.S. Diploma or GED
- Preferred bachelor's degree
- Required 4 years Managed care, claims processing, and/or configuration of benefits/contracts/fee schedules/medical policy payment rules
- A bachelor's degree may substitute for two (2) years of required work experience
