The Configuration Analyst is responsible for the activities related to system configuration and new health plan implementations, for accurately interpreting specific Health Plan Benefits, Contracts, and Payment Rates as well as additional business requirements and converting these terms to configuration parameters. This position is also responsible for coding, updating and maintaining provider contracts, fee schedules and various system tables through the user interface. This position will also serve as a peer auditor for provider data loads and updates.

• Interpret provider contracts and build custom fee schedules, codifying contract terms into the fee schedules in the system.
• Perform Fee Schedule and Benefit QC to ensure the system is set up correctly before releasing the into production.
• Understand all relevant payment methodologies, including but not limited to Medicare, Medi-Cal,, RBRVS, DRG, APR-DRG, OPPS, Per Diems and Case Rates.
• Understands and can construct financial responsibility tables and check for accuracy against Health Plan Documents.
• Understands how to build/maintain Benefit Rules & Benefit Records (Detail Option Records).
• Understands how to translate Health Plan EOC’s into system Benefit Tables.
• Conducts Unit Testing when
• Research and resolve claim/ issues, pended claims and update system as
• Reviews current benefit and DOFR configurations and suggests improvement processes to ensure systems are working more efficiently and improve quality.
• Supports Claims staff with complex claims
• Performs other related duties as assigned.
• Performs peer auditing for provider demographic loads

• High School Diploma or General Education Development (GED) required
• Bachelor's degree in business or health care administration/other related field preferred or 3 years experience in configuration/benefits and/or medical claims processing.
• Knowledge in medical terminology, ICD-10, CPT and HCPCS.
• Strong critical thinking and analysis skills; verbal and written communications, and interpersonal interactions (e.g. partnering, conflict management, consulting, etc.).