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Analyst I - Claims Systems Configuration

Date: Aug 9, 2019

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 2974 

 

Position Summary/ Purpose

 

Under the direction of the Supervisor of Business Systems Configuration, the Analyst is responsible for managing moderately complex system configurations within the Business System. The primary functions of this position include but are not limited to, accurate interpretation of state, federal, and contractual guidelines related to benefits, fee schedules, contracts, division of financial responsibility (DOFR), codification of services, and business requirements and translating them into configurable parameters within the Business Systems. The Analyst is independent and acts as a subject matter expert for the business areas by helping to drive decisions related to system configuration. The incumbent will develop and maintain comprehensive documentation of business and technical specification requirements. The Analyst will facilitate communication and formally report findings to various department heads and staff in a manner that is appropriate to the skill level and technical expertise of the audience. This position will be required to train and help educate other team members within the unit as necessary.

 

Major Duties/ Responsibilities

 

  1. Assist with the development of configuration standards and best practice guides for maintaining efficiency, accuracy, automation and successful integration with internal and external systems and programs.

  2. Analyze and translate business specifications into detailed technical specifications based on system functionality, and develop non-systematic workaround processes when necessary.

  3. Track incoming requests and issue resolution through Access and Workfront tools.

  4. Identify and communicate impact of system enhancements or configuration changes on integrated systems and processes.

  5. Monitor and work daily System Configuration inventory and ensure compliance with established service level agreements and regulatory timelines.

  6. Configure and maintain moderately complex claim related system builds with multi-tiered functionality and interrelated system dependencies, including but not limited to Procedure and ICD10 code updates, Meditrac Events, Regulatory change research and analysis, Workfront and TFS ticket triage, Contracts, and Product codes.

  7. Develop and maintain business requirements for the automation of coding updates.

  8. Assist Contracting team with drafting appropriate contract fee schedule language to be in line with system adjudication capabilities and coding standards.

  9. Track, test, and approve new system functionality, enhancements, and bug fixes, including the development and execution of test plans and scripts.

  10. Perform weekly/bi-weekly audit of check run claims to proactively identify potential system configuration issues before claims are released.

 

Education   Requirement

Bachelor's degree required.

 

Specialized Knowledge/Skills

  • 2-4 years experience with the development and remediation of complex system configurations, including capitated provider configurations

  • Knowledge of Medicare and Medi-Cal fee schedules and benefit structure, and regulatory billing guidelines

  • Skilled in the use of Microsoft Excel

  • Knowledge of CMS, DHCS, DMHC, NCQA rules and regulations preferred

  • Extensive knowledge of CPT, HCPCS, Revenue, ICD10 coding rules and guidelines

  • Familiar with basic medical claims processing

  • Experience in major managed care system migration/implementation preferred

  • Extensive knowledge of general managed care operations required, delegated plan model preferred

 

Abilities

  • Basic knowledge of relational database structure
  • Ability to work independently and solve complex problems with little to no assistance
  • Exceptional problem solving and critical thinking skills
  • Strong presentation and written communication skills
  • Ability to effectively manage multiple competing priorities

 

Starting Salary: $49,192  - $62,004  

some flexibility, commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles

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