Product Configuration Quality Analyst

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Reporting to the Product System Configuration Supervisor, the Product Configuration Quality Analyst is responsible for ensuring the integrity of all claims system configuration created and maintained by the Product System Configuration team. The Product Configuration Quality Analyst audits claims system configured by the Application Architects and Analysts to ensure accurate adjudication of claims. Ensure all Business Rules are configured correctly in the claims system. Support testing efforts within an agile team and execute all levels of testing (System, Data validation, Integration and Regression). The Product Configuration Quality Analyst utilizes quality auditing tools, identifies trainings needs, and collaborates on effective and efficient methods for accurate and quality system configuration.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Education & Requirements 

• Three (3) years of experience of auditing complex system configuration required
• Three (3) years of experience in Managed Care required
• Experience with claims review required
• Experience in claims analysis/auditing preferred
• Experience in major managed care system migration/implementation preferred
• Bachelor’s degree in IT or Business from an accredited institution required
  • In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position: one (1) year of general healthcare experience plus three (3) years of claims analysis experience is required
  • This experience is in addition to the minimum years listed in the Experience Requirements above

Key Qualifications

• Comprehensive knowledge and understanding of:
  • Regulatory compliance and how configuration changes affect regulatory adherence
  • CPT, HCPCS, Revenue, ICD-10 Coding rules and guidelines
  • General managed care operations and delegated plan models
  • CMS, DHCS, DMHC, NCQA rules and regulations
  • Encounters, EDI submissions, provider web portals, integrated NCCI applications, and overall data mapping
  • System and application process integrations and algorithms
  • Medicare, Medi-Cal, and Covered California benefit structure and regulatory billing guidelines
  • Medicare, Medi-Cal, and Covered California claim processing guidelines
  • Relational database structure
  • Testing and audit methodologies
• Strong skills in performing independent root cause analysis, developing test cases, and documenting findings
• Skills in Microsoft Excel, Access, and SQL applications
• Exceptional problem solving and critical thinking skills
• Strong presentation and written communication skills
• Ability to interpret regulatory changes and assess the need for configuration updates
• Ability to identify training gaps and advise leadership on quality trends
• Proven ability to:
  • Operate as an independent reviewer and provide objective assessments under tight schedules
  • Work independently and solve complex problems with little to no assistance
  • Effectively manage competing priorities
  • Ensure compliance and quality assurance standards are met
• Schedule may adjust based on business need which may include evenings, holidays, and weekends to ensure completion of projects and to meet deadlines

Start your journey towards a thriving future with IEHP and apply TODAY!

Pay Range

• $80,059.20 USD Annually - $106,059.20 USD Annually