Configuration Analyst

Location:Long Beach, CA

Duration:6 months

Summary: -

• Responsible for the daily configuration maintenance within the Configuration Information Management (CIM) Operations Team.
• Responsible for interpreting specific State and/or Federal Benefits, Contracts as well as additional business requirements and converting these terms to configuration parameters.
• Also responsible for coding, updating and maintaining benefit plans, provider contracts, fee schedules and various system tables through the user interface.

Essential Functions: -

• Receive information from Health Plan or Corporate for update of information in computer system(s).
• Analyze data by applying knowledge and experience to ensure appropriate information has been provided.
• Apply previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system(s) as necessary.
• Analyze and interpret data to determine appropriate configuration changes.
• Unit test simple configuration changes.
• Maintain thorough and concise documentation for tracking of all provider, contract, benefit or reference table configuration change request forms (CCRF) for quality audit purposes.
• Monitor claims queues to identify issues, makes recommendations, and implements configuration changes to improve claims TAT and accuracy.

Knowledge:

• Intermediate level of knowledge in Microsoft applications Intermediate level of knowledge in medical terminology, ICD-9, CPT and HCPC
• Ability to work independently as well as within a team
• Ability to articulate simple to moderate configuration solutions

Required Experience:

• 5-7 years healthcare experience, Medicare and Medicaid a plus.
• 5-7 years Claims Operations or application vendor experience.
• 5-7 years experience interpreting benefits, contracts and other business requirements.
• 5-7 years experience with medical coding initiatives and coding guidelines.

Day to day responsibilities:

• QNXT system configuration,
• Claims resolution review,
• inventory claims monitoring,
• root cause analysis of claims issues.

Required Licensure: QNXT certified Minimum years of experience: 5years QNXT configuration, 10 years healthcare or claims experience.