Configuration Systems Analyst III

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee and establish system configuration requirements.

• Manage the definition of requirements, documentation, design, testing, training, and implementation support utilizing suitable templates or analysis tools.

• Generate and utilize reports to analyze and categorize data, address discrepancies, and provide solutions to departmental challenges.

• Identify, manage, and document unresolved issues, configuration designs, and final resolutions within the change management system.

• Review and interpret regulatory items, delivering necessary updates punctually.

• Create standard code sets and reimbursement design templates.

• Plan and execute new software releases, including testing and training phases.

• Engage in meetings with business owners, users, and IT to develop solutions that meet requirements and expectations.

• Lead configuration initiatives during payment policy meetings and present findings to committees.

• Coordinate annual benefit changes with internal resources.

• Analyze system efficiencies and document the effectiveness of current systems; develop strategies for improvement and leverage.

• Manage reimbursement reviews and implement appropriate changes.

• Direct the development and execution of test plans and scenarios for reimbursement designs and related processes.

• Conduct audits of configuration for accuracy and internal controls to reduce fraud, abuse, and overpayment issues.

• Anticipate customer needs and align products and services to meet those needs.

• Ensure that system processes and documents exist as a foundation for system logic.

• Manage resources and communication to enable the completion of work.

• Mentor the use of tools to define requirements.

• Carry out additional duties as assigned.

⛳️ Requirements

• A High School Diploma or GED is mandatory.

• A Bachelor’s degree or equivalent relevant work experience is preferred.

• A minimum of five (5) years of experience in health plans, including three (3) years in configuration or clinical editing software, is required.

• Experience with Facets or a comparable system is preferred.

• Exceptional computer skills and proficiency in Facets.

• Advanced knowledge of Microsoft Suite, including Word, Excel, Access, and Visio.

• A solid understanding of database relationships.

• Familiarity with DRG and APC reimbursement methods.

• Knowledge of CPT, HCPCs, and ICD-CM Codes.

• Familiarity with HIPAA Transaction Codes.

• Strong listening and critical thinking skills.

• Effective problem-solving abilities with keen attention to detail.

• Excellent written and verbal communication skills.

• Capability to work independently as well as collaboratively in a team setting.

• Strong interpersonal skills and a high level of professionalism.

• Ability to develop, prioritize, and achieve goals.

• Understanding of the healthcare sector and knowledge of Medicaid and Medicare.

• Proficient in medical coding and claims processing.

• Customer service orientation.

• Knowledge and training in Facets.

• Ability to manage vendor relationships.

• Certification as a Medical Coder (CPC) is preferred.

🏝️ Benefits

• Potential bonus tied to company and individual performance.

• A substantial and comprehensive total rewards package.

• Support for employee total well-being.