Job description

The Configuration Solutions Analyst must have a thorough understanding of the configuration of business rules that support reimbursement policies and methodologies, member/provider contracts, and claims adjudication and correspondence and must have demonstrated strong analytical, technical and problem-solving skills.

Responsibilities:

• Configures and maintains the business rules within the AHA claims adjudication ecosystem.
• Configures the HealthRules software from development into the testing and production phases.
• Provides application and technical support for the HealthRules software as well as troubleshooting for end users.
• Identifies researches and resolves inaccuracies and inconsistencies in the business rules as they impact claims payment and other upstream and downstream transactions.
• Determines how to migrate PHO’s to the new system.
• Engages in intake with business clients to evaluate business requirements.
• Recommends and implements benefit setup based on knowledge of system configuration capabilities and information obtained from business clients.
• Independently evaluates business procedures and problems.
• Participates in business requirements gathering sessions to identify specifications and solutions.
• Creates test case scenarios for application and configuration testing and ensures appropriate testing has been completed before the software enters the production phase.
• Identifies and assesses potential problems and performs and implements system enhancements, modifications and upgrades.
• Defines business client data reporting and trending reports and makes recommendations to management.
• Designs and develops user system documentation.
• Works with IT to define business systems requirements.
• Performs investigation, evaluation and documentation of system design findings.
• Proficiency in Healthcare and Health Plan terminology, medical coding (e.g., CPT, HCPCS, ICD9, CDT, Revenue, DRG and other relevant medical and industry- standard codes)

Requirements:

• Bachelor’s degree in Business Administration, Management Information Systems, Computer Science or equivalent work experience.
• In lieu of degree, minimum 3-4 years proven configuration experience, preferably on Facets, HealthRules, Diamond, Amisys Advance or similar Payor System.
• Strong project management skills needed.
• 2+ years HealthCare operations or Healthcare claims processing experience.

Job Type: Contract

Pay: $70.00 - $75.00 per hour

Schedule:

• 8 hour shift
• Monday to Friday

Application Question(s):

• Do you have configuration experience, preferably on Facets, HealthRules, Diamond, Amisys Advance or similar Payor System?
• Do you have Healthcare operations or Healthcare claims processing experience?
• Do you have proficiency in Healthcare and Health Plan terminology, medical coding (e.g., CPT, HCPCS, ICD9, CDT, Revenue, DRG and other relevant medical and industry- standard codes)?

Education:

• Bachelor's (Preferred)

Work Location: Remote

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