Configuration Analyst

Configuration Analyst

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Our MissionKern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

General Purpose:


This position is responsible for managing core system configuration, health plan implementations and conversions within the System Configuration team. The primary responsibilities include the accurate interpretation of specific information such as state and/or federal guidelines that impact benefits, contracts, business requirements and configuration within the core systems.

The ConfigurationAnalyst III elicits complex business requirements through group meetings, interviews, observation, and/or existing systems, and business or policy documentation.This role independently mentors and contributes to the System Configuration team with complex and comprehensive documentation of the technical requirements or systems modifications in a format that facilitates a business and technical communication and understanding amongst the business department or individuals.The ConfigurationAnalyst III must have the ability to independently analyze or mine data, draw sound conclusions, and is able to interpret and follow detailed and precise written and oral instructions such as checklists, process diagrams, and policy.The ConfigurationAnalyst III will lead communications and facilitation efforts to present the documented findings and results from an analytical engagement.The position will be required to work with and mentor people of various professional, vocational, and educational backgrounds.

Essential Duties and Responsibilities:

• Comprehend, analyze, and configure the claims core system including plan and carriers, program edits, benefits, procedure codes, service groups, fee schedules, provider contracts, affiliations, and all other configuration.
• Comprehend, analyze, and configure the medical management core system including episode, sentinel rules, integration, data synchronization, letters, and all other configuration.
• Ability to interpret simple and complex provider contracts and amendments, define requirements to configure, test, and promote within environments, and audit.
• Responsible for testing and remediation of all core system updates and changes.
• Researches and develops recommendations for enhancements and/or improvements by leading the analysis of existing processes, procedures, requirements, and utilization of existing systems.
• Provides guidance in problem identification and the implementation of solutions that address gaps and configuration needs.
• Independently works, or under the direction of Project Manager or Senior Analyst, with Executives, Management, Staff, or Business analysts to identify, document, and redesign complex business concepts or processing conflicts.
• Lead and mentor in areas that need cross-training and independently provide knowledge and documentation exchange to educate team members in Analytical roles in support of team redundancy.
• Provide formal user education with software productivity and technical tools such as Microsoft Office, Visio, Team Foundation Server, or Attachmate to document business and technical process requirements related to a technology system.
• Comprehend, analyze, and document business or process requirements using personal interviews, document analysis, meetings, surveys, process documents, or actual scenarios.
• Take on duties of a Project Manager for small projects using standard PMBOK processes to identify requirements, resources, and stakeholders using standard analysis techniques.
• Analyze and document functional business environments that facilitate work throughout the company.
• Develop complex business requirements and specifications through internal and external research to complete technical analysis, and articulate research back to various skill levels.
• Facilitate business meetings leveraging the Agile process to assist business units in the What session to ensure the creation and documentation of stories and acceptance criteria.
• Work with Configuration and Project teams in the Agile How session to understand technical requirements related to the business stories and acceptance criteria.
• Effectively communicate and collaborate with internal and external customers in support of analytics or problem resolution.
• Successfully engage in multiple complex initiatives simultaneously
• Analyze and evaluate information gathered from multiple sources to resolve reconciliation conflicts.
• Possess excellent verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts.
• Comprehensive understanding of the various department technological resources and their roles in order to utilize various forms of electronic resources in everyday communications.
• Understanding and experience with the American National Standards Institute (ANSI) formats that govern healthcare Electronic Data Interchange (EDI).
• Proficient with the structure query language (SQL) for analytical data mining, software development, TFS, and business reporting.
• Comprehend and implement system configuration changes of the managed care core system software to process data transactions for business functions such as eligibility, claims, authorizations, and case management.
• Designs, develops and/or assist in the testing and implementation of software systems used by the organization.
• Understanding of medical terminology to include ICD, CPT, and HCPCS coding systems.
• Identify and create personal process checklists that will be used to process Kern Health Systems (KHS) programs and applications to support departmental activities.
• Tactfully identify issues, makes recommendations, and implements configuration changes to improve automation and accuracy.
• Ability to handle fluctuating volumes of work and be able to prioritize work to meet deadlines and needs of stakeholders.
• Creates management reporting tools to enhance communication on configurations updates and initiatives.
• Responsible for maintenance of existing systems including impact analysis, coordination with IT disciplines, and testing with IT and business units.

Employment Standards


Education:


Bachelors degree in Computer Science, Mathematics, or related field AND five (5) years progressive experience in a Configuration Analyst capacity or similar Analytical position for a medium to large organization with a structured IT department in healthcare.

OR
Experience:


Healthcare experience: 9+ years.
Claims Operations or application vendor experience: 3 + years.
Benefit and Contract Configuration experience: 3+ years
Experience interpreting benefits, contracts and other business requirements: 3+ years
Experience in medical coding initiatives and coding guidelines: 3 + years
The incumbent must have basic technical skills that come from a Degree in Information System
or 6-8 years of general analytical experience.

Specific system requirements are identified in the Configuration Standards matrix and based on individual system assignments.