The Senior Provider Configuration Analyst will be responsible for the configuration of MetroPlusHealth's systems to ensure that claims are processed according to Provider contracts.
Scope of Role & Responsibilities - Configure provider reimbursement and create and maintain fee schedules.
- Analyze departmental requirements needed to develop long and short-term plans.
- Ensure system processes and services are aligned with the needs of the department.
- Analyze the system to ensure claims are processed correctly to protect the company from liabilities.
- Collaborate with MetroPlusHealth's system consultants to correct errors, rectify omissions, and investigate system issues.
- Identify potential system problems for claims resolution.
- Review test cases to ensure they are in accordance with requirements and assist with overall testing processes.
- Conduct ongoing reviews of systems and processes to ensure accurate and optimum setup for both provider and claims.
- Receive, coordinate, and manage requests for Systems Modifications.
- Maintain and track open issues and coordinate release testing.
- Assist with the system migration to HealthEdge HRP and Source products.
- Run reports and perform analysis using SQL.
- Create and maintain an inventory of pricing templates and their contents
- Monitor and Manage Core Systems performance
- Respond to escalated issues from various MetroPlusHealth Departments.
- Perform and assist with any other functions as required by the Director of Provider Contract Configuration
- Participate in special projects and strategic initiatives as needed.
Required Education, Training & Professional Experience - A Baccalaureate Degree from an accredited college or university required, Computer Science preferred; and
- Six (6) years of progressive, responsible experience in configuration for data processing, computer systems and applications;
- Experience with HealthEdge HRP and Source products required.
- Demonstrated experience supporting system configuration, workflow analysis, and technical documentation in a healthcare or claims environment.
Professional Compentencies - Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication
- Ability to work independently, manage multiple priorities, and maintain attention to detail.
#LI-Hybrid
