Location: Orange, California US
Job Number: 1588
Position Title: Configuration Analyst
The Configuration Analyst understands the various types of reimbursement and contracting arrangements, that need to be configured in the Managed Care System to support the accurate payment of claims. In addition the Analyst may be the primary contact for one or more claims systems interface applications and is expected to provide a high level of expertise with matters relating to this interface and its functionality. Collaborating with IT and Business to ensure accurate claims payment consistent with contract and Medicare guidelines. Performs other duties as assigned by Management.
(May include but not limited to)
- Initiate complex claims auto reprocessing efforts, utilizing system modules to minimize manual intervention by claims examiners.
- Perform root cause analysis to resolve claims payment discrepancies and system or process inefficiencies.
- Create quality reports to audit the integrity of the configuration changes to the system.
- Identify solutions to data issues.
- Ensures system is updated timely with all standard Coding (e.g.: CPT; HCPCS; ICD; Revenue Codes)
- Provides recommendations related to configuration design and understands impacts of provider contracts and pricing.
- Conducts preliminary evaluation of contractual agreement prior to execution to determine system configurability.
- Analyzes provider contracts to determine the best approach for loading data elements into the Managed Care System.
- Assists with testing of new version releases of Managed Care System as they relate to benefits, division or financial responsibility and pricing. Document results.
- Analyzes and make recommendations to management regarding system enhancements needed.
- Acts as the subject matter expert related to Managed Care System.
- Assists in establishing, and documenting policies and procedures in support of standardized and accurate configuration.
- Performs problem resolution of configuration issues.
Minimum five (5) years of experience as a configuration analyst / business analyst or five (5) years in healthcare or managed care, with knowledge of provider contracting and reimbursement, payment methodologies and fee schedules, claims, referral authorizations and code review.
- Bachelor's degree OR four (4) years of equivalent experience in a directly related field
- High School Diploma or General Education Development (GED) required
- General understanding of medical terminology, claims processing, logical thinking and understanding of relational database is required
- Knowledge of state and federal regulations
- Strong critical thinking
- Significant experience in research
- Excellent interpersonal, communication, and listening skills are required
- Advanced knowledge in health care delivery from a payor and provider perspective along with health insurance industry practices and standards
- EZ-Cap Experience
- Proficient in MS Office Suite of products
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable
may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
- The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Location City: Orange
Location State: California
Community / Marketing Title: Configuration Analyst
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.
EEO Employer Verbiage:
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact email@example.com.