MSO SYSTEM CONFIGURATION ANALYST I

Description

The MSO System Configuration Analyst is responsible for the major managed care systems configurations, health plan implementations and conversions within the System Configuration team.  

The primary responsibilities include the monitoring of monthly encounter data and report submissions to contracted Plans, DHCS, and CMS; review correspondence and take appropriate follow up actions to accomplish data accuracy and completeness requirements for all managed care programs including PACE, Medicare Advantage and Medi-Cal.  Develop reports to monitor system performance and promote integration and automation of systems workflows.  Other responsibilities include monitoring fee schedule updates as published by CMS and DHCS and transform into system configuration scheme, maintenance of benefit modules, provider profiles set-up (demographic and contracts affiliations), fee schedules, regular coding updates and various system tables through the user interfaces. 

The position is also required to produce data reports as demanded by contracted health plans, DHCS, and CMS; reconcile eligibility and capitation data discrepancies between plans and NEMS data. 

This position requires high level of critical thinking skills, current technical knowledge of MSO operations, processes, workflows, and understanding to the managed care operational structure, coding, benefits, and relevant degree of creativity and latitude.

ESSENTIAL JOB FUNCTIONS:

• Interprets state and federal guidelines that impact managed care system configuration and convert configuration parameters within the MSO core systems.
• Develops, edits, and maintains the EZ-Suite system configuration items; automate system workflows to promote operational efficiency.
• Monitor monthly encounter data and other report submissions; review correspondence reports and take appropriate follow up actions to accomplish data accuracy and completeness requirements,
• Assist in conducting system testing, validation and analyze outputs and results to allow for continuous improvement of the overall QA process for the MSO EZ-Suite system accuracy, integrity, and performance.
• Communicates with other MSO operational teams to understand workflow needs; design, develop and refine Work Queue processes in core managed care systems to strengthen system enhancement activities including data mapping, system integration and workflow automation to meet and improve operation needs.
• Creates and analyzes statistics reports for other operational teams in assist of evaluating business performance links to MSO medical management services.
• Responds to system configuration flaws/errors and unresolved issues, report and propose to MSO Director and EZCAP Product Development team for resolutions.
• Supports MSO audit activities performed by various entities, including contracted Health Plans, DHCS, and CMS.
• Performs other job duties as required by manager/supervisor.

QUALIFICATIONS:

• Completion of a 4-years degree from an accredited University in System Analysis, Computer Programming or other relevant area of study is required. Associate Degree may be considered with 5 years combined working experience in managed care application and EHR application focusing on system configuration, development, enhancement, and workflow optimization duties.
• Three (3) years technology and business analysis experience in Managed Health Care industry with working knowledge of Benefits, Fee Schedules, and Provider Contracts is required.
• Working knowledge of State/Federal healthcare compliance and coding standard (HIPAA, ICD-10, CPT, HCPCs) is required;
• Must have strong analytical and problem-solving skills across a wide variety of configuration and technical issues.
• Demonstrated ability to use Microsoft Access, Excel, Crystal Reports, Report Builder and SQL Server Reporting Services.
• Ability to self-manage in a detail-oriented environment.
• Good organization and prioritization skills, outstanding in time management.
• Ability to deliver quality work product reliably and consistently on target dates.
• Strong written and verbal communication skills to allow for effective communication at any level.

LANGUAGE:

• Must be able to fluently speak, read and write English.
• Fluent in other languages are an asset.
   

STATUS:

• This is an FLSA NON-exempt position.
• This is not an OSHA high-risk position.
• This is a full time position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).
 

Salary : $40 - $45