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Configuration Analyst

Houston, TX 77401

Posted: 11/04/2024 Industry: Health Care, Nurse, Other Job Number: 11/4/2024

Job Description

2 years of managed care, claims processing, and/or configuration
of benefits/contracts/fee schedules/medical policy
payment rules.

• 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 andservice 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.

Job Requirements

Skills:

• 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.


A bachelor's degree may substitute for the required work experience.

Additional Information

Hybrid -M-F (8-5)

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