What are the responsibilities and job description for the Provider Data Mgmt. Configuration Analyst - PCHP position at Parkland Health?
Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.
Primary Purpose
Parkland Community Health Plan’s (PCHP’s) Provider Data Management Configuration Analyst is responsible for configuring and maintaining provider data in the claims systems to ensure accurate claims adjudication, accurate provider data in the PCHP provider directory, and compliance with health plan policies.
Minimum Specifications
Education
Operations
Primary Purpose
Parkland Community Health Plan’s (PCHP’s) Provider Data Management Configuration Analyst is responsible for configuring and maintaining provider data in the claims systems to ensure accurate claims adjudication, accurate provider data in the PCHP provider directory, and compliance with health plan policies.
Minimum Specifications
Education
- Bachelor’s degree in Information Systems, Healthcare Administration, or a related field
- Three years of experience in provider data configuration, claims systems, or health plan operations.
- Experience with QNXT or similar systems required.
- May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.
- Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines. Ability to communicate complex information in understandable terms.
- Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization.
- Excellent analytical and problem-solving skills.
- Proficiency in data analysis and testing methodologies, such as Excel or SQL
- Strong technical knowledge of healthcare configuration systems (e.g., QNXT).
- Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities.
- Ability to write clearly and succinctly with a high level of attention to detail.
- Proficient computer and Microsoft Office skills. Ability to learn new software programs.
- Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.
Operations
- Analyze, configure, and maintain provider data to support operational and business requirements.
- Supports provider contract implementation in QNXT and other integrated platforms / systems.
- Perform unit testing, validation, and troubleshooting of configuration updates to ensure accurate claims adjudication.
- Collaborate with Provider Network and Contracting team to implement provider agreements.
- Support development of workflows of provider data configuration processes.
- Maintain documentation of configuration rules, updates, and procedures.
- Monitor system performance and recommend improvements to optimize configuration processes.
- Research and resolve provider-related configuration issues, including claims rejections or adjudication errors.
- Provide technical support and expertise to resolve provider data-related issues within the QNXT system.
- Integrate health literacy principles into all communication including Members and Providers.
- Support strategies that meet clinical, quality and network improvement goals.
- Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed.
- For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination.
- Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements.
- Assist in preparation and submission of regulatory files, ensuring system configurations meet compliance requirements.
- Ensure that all configurations and processes comply with federal, state, and industry regulations, including Texas Medicaid standards.
- Stay updated on regulatory changes and implement necessary adjustments to system configurations.
- Promotes and supports a culturally welcoming and inclusive work environment.
- Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
- Adheres to organizational policies, procedures, and guidelines.
- Completes assigned training, self-appraisal, and annual health requirements timely.
- Adheres to hybrid work schedule requirements.
- Attends required meetings and town halls.
- Recognizes and communicates ethical and legal concerns through the established channels of communication.
- Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
- Maintains confidentiality at all times.
- Performs other work as requested that is reasonably related to the employee’s position, qualifications, and competencies.
- Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
- Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
- Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.
