What are the responsibilities and job description for the Configuration Analyst position at eTeam?
Job Title: Configuration Analyst/Claims Research Analyst
Duration: 03-06 Months High possibility of extension
Location: Houston, TX 77030
Schedule Notes: Hybrid -M-F (8-5) 2 days a week for local candidate- Onsite Tues, Thurs and every other Friday
Job Summary:
Duration: 03-06 Months High possibility of extension
Location: Houston, TX 77030
Schedule Notes: Hybrid -M-F (8-5) 2 days a week for local candidate- Onsite Tues, Thurs and every other Friday
Job Summary:
- The configuration analyst should have strong knowledge in at least one of the areas under the purview of Med Policy
- Configuration: benefits, contracting, coding, fees schedules, or claim edits (CES).
- The Configuration Analyst role is 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.
- 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 contract, 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 process
- Handles fluctuating volumes of work and prioritizes work to meet deadlines and user needs of the Health Plan.
- 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.
- Collaboration, written and verbal communication, detailed analytical and organizational skills; ability to manage time with competing priorities; self-motivation; leadership; and ability to work independently with minimum supervision.
- 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.
- At least one EPIC Tapestry certification strongly preferred.
- From a technical perspective it would be idea they have experience with the following three buckets
- Experience in Texas Medicaid
- Claims Specialist or Claims Research Analyst experience
- Specifically experience working adjustments/appeals
- Tapestry Benefits or Tapestry Contracts configuration experience
- Required- H.S. Diploma or GED
- 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.
