H

Healthcare Management Administrators

Configuration Analyst 2

Business OperationsPosted on Nov 9
Full-time

About the Job

Requirements

  • A high school diploma or equivalent experience is required.
  • Three to five or more years of recent relevant health plan configuration experience are required.
  • Comprehensive understanding of administered benefits and different plan types is required.
  • Understanding of self-funded plan structures, accumulators, stop-loss, and employer-specific plan variations is required.
  • Ability to analyze benefit documents, including Summary Plan Descriptions and plan summaries, and translate them into system rules is required.
  • Understanding of regulations that affect benefit design, including the Affordable Care Act, Mental Health Parity, and Internal Revenue Service rules for administering high-deductible health plans is required.
  • Experience troubleshooting configuration issues and validating system outputs is required.
  • Familiarity with claims platforms or health reimbursement plan systems used by third-party administrators is required.
  • Ability to create and run SQL queries is recommended.
  • Ability to analyze and understand medical claims adjudication logic is required.
  • Clear and effective verbal and written communication skills are required.
  • Strong interpersonal skills and the ability to work with team members at all levels are required.
  • A background screen is required prior to employment.
  • Employees may encounter protected health information in the regular course of work and must use and disclose it on a need-to-know basis according to company policies and procedures.

Responsibilities

  • Perform system configuration and validation for new and renewing clients.
  • Collaborate with business partners to gather and clarify requirements.
  • Review prior benefit plans and make recommendations for new group implementations, including system capabilities, regulatory requirements, and benefit design; present recommendations to new clients.
  • Configure benefits in the claims system and prepare corresponding end-user documentation for new group implementations as needed.
  • Create claims system benefit configuration revisions and prepare corresponding end-user documentation for renewing clients and off-cycle benefit changes.
  • Document workflows, configuration decisions, and process updates.
  • Troubleshoot configuration issues and recommend solutions.
  • Review change requests for completeness and alignment with existing processes.
  • Provide training and education to Plan Configuration Analysts and assist in developing training materials.
  • Communicate status updates and risks to senior analysts and the Plan Configuration Manager.
  • Review and respond to applicable TechOps Support tickets and business process outsourcing claims queries as needed.
  • Manage the single sign-on tool for non-preferred pharmacy benefit managers.
  • Conduct peer-to-peer audits of claims system configuration.
  • Work with a Level III analyst to set up BlueCard requirements, including negotiations with Consortium Health Plans, processing Capitated Billing Format payments and prior authorization requests, and setting up plan prefixes.
  • Work with the Finance team to conduct explanation of benefits setup auditing as needed.
  • Participate in code categorization decisions and lead reviews of annual compliance requirements related to preventive services.
  • Participate in department and company-wide projects as needed.

Desired Qualifications

  • Ability to create and run SQL queries is recommended.

About the Company

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