Professional, Configuration Analyst
Under the direction of the Leader of Pricing and Claims Configuration: The Professional, Configuration Analyst develops and implements configuration into the Managed Care systems utilized by MVP to accommodate systematic provider reimbursement, adjudication rules and configuration solutions that enhance business processes/efficiencies. Responsible for interpreting and validating the accuracy of requests and development of solutions in support of accurate and timely configuration that leads to efficient and accurate claim adjudication. Participates in the development and implementation of strategies required for Corporate and Department projects and business process improvement initiatives. Responsible for the accurate and timely configuration and testing of provider contracts, claims adjudication rules and all areas of configuration including but not limited to; processing control agents, procedure codes, explanation codes, system messages in Facets, NetworX, Rate Manager, WebStrat and all other applications as applicable. Responsible for conducting analyses as requested and producing detailed reports to support departmental or business operations. Maintains detailed documentation related to work assignments to support audit processes. Creates supporting claim reports related to work assignments that are sent to other areas for review. Collaborates with internal customers to define and understand configuration requests and requirements.
Performs system testing and utilizes quality assurance methods to validate accurate configuration. Creates test plans, test case scenarios and detailed test scripts in support of departmental quality control. Proactively identifies and communicates configuration defects and works to help close gaps in documentation and processes. Investigates and addresses operational gaps including the design and implementation of solutions as necessary in order to reduce risk exposure and accurate claims pricing and processing. Performs post-implementation review and analyses of projects to validate the accuracy of configuration. Responsible for the accurate and timely investigation and resolution of inquires related to claims pricing and payment. Ensures timely delivery of all assigned configuration and testing projects and adheres to departmental controls. Represents the department on committees and project teams. Performs other duties as assigned.
Associate degree or relevant work experience within health care and/or systems configuration.
Experience using query tools to extract data from relational databases. Configuration experience strongly preferred. Experience in the health care field and/or business analysis background desired.
- Ability to manage multiple assignments with a high level of autonomy and independence.
- Highly detail-oriented with strong analytical, technical and interpersonal skills.
- Adept in Microsoft Word, Excel, Access and the management of data and reports.
- Exceptional skills in critical thinking and problem solving.
- Excellent organizational and communication skills.
- Ability to work collaboratively and professionally