Sr. System Configuration Analyst

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Sr. Systems Configuration Analyst is responsible for maintaining all pricing and coding within the Managed Care System. Collaborating with IT and Business to ensure accurate claims payment consistent with contract and Medicare guidelines. The Configuration Analyst understands the various types of reimbursement and contracting arrangements and/or benefits administration data elements that need to be configured in the Managed Care System to support the accurate payment of claims. Performs other duties as assigned by Management.

GENERAL DUTIES/RESPONSIBILITIES :
1.  Serves as a subject matter expert for configuration change management testing and related best practices

2. Analyze and interpret documents related to claim system configuration, including but not limited to provider contracts, division of financial responsibility (DOFR), health plan benefits, authorization rules and workflow to ensure accurate system configuration.

3. Conduct regular audits and validation of system configuration which include but not limited to provider contract rates, DOFR, health plan benefits, authorization rules and workflow to ensure accuracy, compliance with regulations, company policies and contracts. Identify and address discrepancies or issues promptly.

4. Trouble shoot and resolves configuration-related issues, working closely with internal teams and external vendors as needed.

5. Performs user acceptance testing to ensure system configuration accuracy.

6. Collaborates with cross-functional teams to identify configuration needs and implement effective solutions.

7. Collaborates with internal and external auditors to support the audit process related to configuration, including the preparation, organization, and submission of necessary documentation.

8. Maintains thorough and concise documentation for tracking of all configuration changes and system testing.

9. Recommend process improvements to enhance the efficiency and effectiveness of system configuration.

10. Assists in the development and training of process documentations and workflows.

Job Requirements:

Experience:

• Required: Minimum of 5 years hands-on experience in claims system configuration such as health plan benefits, provider pricing, authorization rules and/or DOFR.

Education:

• Required: High School Diploma or GED

• Preferred: Bachelor’s degree in Health Informatics or 5 years hands-on experience in claim system configuration

Specialized Skills:

• Required:

• Demonstrated experience in managing complex system configurations, performing system audits and resolving configuration-related issues
• Familiarity with payer policies, provider contract terms and health plan benefits
• Problem Solving Skills: strong analytical and effective problem-solving skills, with the ability to interpret complex healthcare documents and translating them to system requirements
• Excellent communication and interpersonal skills, with the ability to collaborate effectively with cross-functional teams
• Detail-oriented with exceptional organization skills and the ability to manage multiple tasks and projects simultaneously
• Working knowledge of healthcare coding systems such as ICD, CPT, HCPCS, revenue codes and other related codes.
• Knowledge of medical claims processing guidelines and different payment methodologies.
• Report Analysis Skills: Proficiency in data analysis and reporting tools such as SQL, Excel, or other healthcare-specific tools.
• Experience with medical claims systems such as Facets, pricing tools such as Optum PPS, and clinical claims editing softwares.
• In-depth knowledge of healthcare regulatory requirements including medical coding and Medicare pricers

Licensure:

• Required: None

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $70,823.00 - $106,234.00

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.

Salary : $70,823 - $106,234