Job Description
Healthcare Claims Configuration Analyst
Remote
Equity Staffing is searching for a Remote Healthcare Claims Configuration Analyst. This position with a Fortune 500 organization. Our client serves more than 85 million people and has a reputation for bold ideas. If you enjoy working with energetic people in a collaborative environment, we want to speak with you!
Position is 100% Remote ***
Specific Duties:
- Execute the build and implementation of benefit plan adjudication rules
- Coordinate the integration or conversion of new clients and/or products as needed, often under aggressive timelines
- Participate in the development and implementation of an enterprise claim platform, providing subject matter expertise on the system configuration and usability components
- Align operational needs with technology requirements
- Develop best practices and standard operational procedures for creating and configuring benefit plans
- Establish consistency and standardization as it relates to tools and processes (deliverable templates, change management processes, business models, process flows, etc.)
- Curate a robust testing suite that is representative of all coverage to better quantify the impact of introducing configuration changes.
- Ability to execute testing to ensure the accurate configuration of business requirements. Analyze issues/defects and debug the system when configuration is not producing the expected results.
- Partner with claim processors, member service and provider service to identify and resolve issues related to the plan configuration
Must have qualifications/experience:
- High School Diploma/GED or equivalent
- Excellent analytical skills with ability to read and understand complex data and make thoughtful, articulate recommendations
- Experience with project methodology (requirements, design, development, testing, and implementation) including understanding Agile, inclusive of Scrum and Kanban
- Must be able to understand complex business processes that cross many functional operational units
- Knowledge of ICD-10, CPT, HCPCS, revenue codes and medical terminology
- Demonstrated proficiency with Microsoft Excel and SQL
- Knowledge and experience in a healthcare environment with HIPAA, ERISA and ACA requirements
- Self-directed with the ability to influence without direct control
- Problem Solving Skills
- Experience working in a fast paced team environment
- Great Multitasker
- Positive Attitude
- Good Typing Skills
- Great Customer Service Skills
- Attention to Detail
- Strong Organizational Skills
- Effective communication skills both written and verbal
- Strong computer skills
- Proficient in Microsoft Office Suite of Tools.
- Critical thinking skills.
- Ability to work with others
Preferred Qualifications:
- Knowledge of commercial health plan design
- Experience assisting in the plan build/plan configuration of claim adjudication platform
- Agile, ready to change direction on the fly