Configuration Analyst

Company: Point32health
Location: Hopedale
Posted on: March 16, 2023

Job Description:

As a participant on the HealthRules Payor (HRP) Configuration Team, the Configuration Analyst will work collectively to achieve the successful implementation and on-going maintenance of HRP (the core claims administration platform). The Configuration Analyst will play a key role in analyzing requirements, building configuration components in HRP, and supporting testing of the system. KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS

• Using an agile approach, analyze requirements, research business and system impacts of requirements, define possible configuration options, implement business approved approach, configure system and support user testing of system configuration.
• Develop a deep understanding of the Health Rules Payor system capabilities for assigned functional area (such as Benefits, Provider Contracts, Members, and Claims) and evaluate requirements to determine the best configuration design.
• Support integration and business process activities that utilize configuration as part of the end-to-end solution to meet business requirements. Creating and/or maintaining testing processes to ensure that configuration changes are implemented correctly and do not adversely affect processing in all operational areas, including: Checking results of test batches against predetermined expected values; Routinely and on an ad hoc basis generating specific test claims to target specific areas of the configuration that have been altered; Adhering to quality control processes for, benefits, code sets, referral/auth rules, and contract configuration processes.
• Provide analysis and documentation that supports on-going management of the configuration including documentation of design, decisions, and requirements in order to support traceability and audits. Qualifications what you need to perform the job EDUCATION: (Minimum education & certifications required)
  • Bachelors degree required. Certification in medical coding is a plus. EXPERIENCE:
    • 3-5 years minimum experience in Health Insurance or delivery with a working knowledge in one or more operational areas including Claims processing, Provider Credentialing & Reimbursement, Product & Benefit Design, Enrollment, or Medical Code sets.
    • Experience as business analyst or system configuration analyst is required with the ability to gather, document, test and implement business requirements. SKILL REQUIREMENTS:
      • The successful candidate must be able to work cooperatively as a team member, possess a strong ability to analyze complex business problems and develop design options, adapt to change, and clearly communicate.
      • Knowledge and experience with Medicare payment methodologies, healthcare claims, and claims adjudication required. Medicaid and other commercial billing requirements and payment methodologies is preferred.
      • Must have the analytical skills necessary to understand the current data structure and operational processes within HRP to identify opportunities for improvement, as well as be able to suggest ways to address business gaps.
      • Deep knowledge of one or more configuration areas (such as Claims, Provider, Enrollment, Benefits)
      • Detailed oriented.
      • Ability to write effective communications. CONFIDENTIAL DATA: All information (e.g., written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies, as well as all applicable laws and regulations at all times. Commitment to Diversity, Equity & Inclusion Point32Health is committed to making diversity, equity, and inclusion part of everything we dofrom product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. COVID Policy Please note: As of January 18, 2022, all employees including remote employees must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law. About the Company Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. This job has been posted by TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law. Req ID: R6130

Keywords: Point32health, Worcester , Configuration Analyst, Professions , Hopedale, Massachusetts