Description
26649 -Configuration Analyst
Rancho Cucamonga, CA 91730
Position type: w2
Contact duration: 9months + (strong possibility of extension)
The Configuration Analyst will understand and interpret Provider contract, Benefits, Authorization and General configuration requirements to translate into Xcelys configuration components, plan benefit contracts offered in the California region. Analyst will be responsible for analysis, system design and input of provider data elements in XCELYS, the host processing system, and other platform applications to support accurate and timely payment of claims.
Performs Configuration Activities (which may include at least one of the following: Institutional and Provider Contracts, Benefits Authorizations, and/or General Configuration such as System Edit Rules, Fee Schedules updates, etc.) within Xcelys Claims Processing system resulting in 100% claim payments consistent with the contractual arrangement(s) made with the Provider, and according to the Groups Evidence of Coverage (EOC)
Ensures the provider, authorization and benefits configuration meets established business rules and procedures.
Modifies the provider contract, authorization rules and benefit plan configuration as required.
Loads new contracts/authorization/benefit configuration into Xcelys.
Uses MACESS workflow to monitor contract updates and contract(s) Matrix/grid.
Performs problem resolution of configuration issues.
Consults with relevant Contract Manager or business analyst to determine appropriate interpretation and configuration of contract terms.
Maintains detailed knowledge and understanding of Xcelys rules relative to claims payment.
Analyzes provider contracts to determine the best approach for loading data elements into the claim processing system
Analyzes benefit explanation of coverage to determine best approach for loading benefits plan offered including co-pays, out-of-pocket maximums and state/regulatory benefits
Analyzes medical management requirement to determine best approach for loading authorization rules into the claims processing system
Develops, documents and executes test plans for configuration testing and validate accuracy of data loaded
Performs problem resolution of configuration issues and documents results for the repository
Coordinates research and resolution of debarred and sanctioned providers and ensures communication of required system updates to Provider Contracting and Claims Operations