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Analyst II - Provider Data Configuration

Date: Apr 6, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 4810 

 

Position Summary/Position

 

Under the direction of management, the Analyst II - Provider Data Configuration is responsible for provider data and finance configuration design, build, testing, and implementation of system builds, understanding the interrelated dependencies within IEHP’s business systems. The Analyst II is as a subject matter expert for the business areas responsible for driving decisions related to complex system configuration through proven experience and analysis of process and results. The Analyst II will also develop and maintain comprehensive documentation of business and technical specification requirements including Business Requirement Documents, Enhancement Requests, Change Request, Decision Recommendation Documents, and Software Requirements Specifications. This position will be required to train and help educate other team members within the unit as necessary.

Major Functions (Duties and Responsibilities)

 

1. Maintain a comprehensive understanding of the system features and capabilities to provide effective support to Users/Team.
2. Configure and maintain moderately complex provider data and finance related system builds and interrelated system dependencies, including but not limited to Transforms, Contract Mappings, Meditrac Events, NDDB, Web Portal and ORACLE integration, Batch Loading Jobs, Claims Analysis, Batch Adjustments and RA and 835 Generation. 
3. Participate in cross functional teams to develop a comprehensive functional and systems level solution test strategy that accounts for the common aspects of the solutions, including cross functional review for such plan.
4. Analyze and translate business specifications into detailed technical specifications based on system functionality and develop non-systematic workaround processes when necessary.
5. Draft and develop detailed Business Requirement Documents (BRDs), Enhancement Requests (ERs), Change Requests (CRs), Software Requirements Specifications (SRSs), and Decision Recommendation Documents as required.
6. Design & develop test plans and test cases to ensure and gauge product quality, while effectively minimizing manual testing - manage creation of test plans, test scripts and test cases and lead in their execution and perform Debugging and Root Cause Analysis on test failures.
7. Track, test, and approve new system functionality, enhancements, and bug fixes, including the development and execution of test plans and scripts.
8. Identify and communicate impact of system enhancements or configuration changes on integrated systems, processes, and regulatory impacts.
9. 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.
10. Effectively interpret and train staff on new functionality and assist in updating Desktop Reference material for interdepartmental stakeholders
11. Conduct cross-training efforts to ensure business continuity.
12. Track incoming requests and issue resolution through monitoring tools.
13. Monitor and work daily System Configuration inventory and ensure compliance with established service level agreements and regulatory timelines.
14. Perform or review audits to proactively identify potential system configuration issues.
15. Effectively work in collaboration with dependent business units with frequent and positive communication and teamwork.

Experience Qualifications

 

Four (4) years of business systems configuration experience  in Healthcare experience required. Experience with the development and remediation of complex system configurations including integrated configurations with medical management systems. Experience in major managed care system migration/implementation required. Experience working with Medicare/Medicaid government programs required. Experience using Customer Relationship Management software for purposes of testing. MySQL, SSMS, SSRS experience required. Analytical experience required.

Preferred Experience

 

Experience in major managed care system migration/implementation preferred.

Education Qualifications

 

Bachelor’s Degree in Business Administration, Health Care Administration, Computer Information Systems (CIS), Management Information Systems (MIS), or other related field from an accredited institution required.


Significant experience may be considered in lieu of degree: In lieu of a degree, a total minimum of eight (8) years of relevant work experience is required. In lieu of degree, a minimum of six (6) years of Health Care or Managed Care Operations experience is required and two (2) years of Provider Data Configuration or claims auditing or Provider Contracting required.

Knowledge Requirement

 

Knowledge of Medicare and Medi-Cal fee schedules and benefit structure, regulatory billing guidelines, EDI 837 and 835 preferred. Knowledge of CMS, DHCS, DMHC, NCQA rules and regulations preferred. Extensive knowledge of CPT, HCPCS, Revenue, ICD10 coding rules and guidelines a plus. Familiar with basic medical claims processing. Basic knowledge of general managed care operations required; delegated plan model preferred. Intermediate knowledge of relational database structure.

Skills Requirement

 

Microcomputer skills, proficiency in Windows applications required. Advanced knowledge of Microsoft Access and Excel applications.  Excellent communication and interpersonal skills. Strong organizational skills. Exceptional problem solving and critical thinking skills. Strong presentation and written communication skills.

Abilities Requirement

 

Professional demeanor. Detail oriented. Ability to work independently and solve complex problems with little to no assistance. Ability to effectively manage multiple competing priorities and adhere to strict timelines.

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

 

Starting Salary: $75,296.00  - $95,992.00  

Pay rate will 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