Configuration Analyst

Maryland  ‐ Onsite
This project has been archived and is not accepting more applications.
Browse open projects on our job board.

Keywords

Description

Configuration Analyst ---Silver Spring, Maryland

Job Summary - This 6+ month contract opportunity is for a Configuration Analyst role for a major health care provider.  The individual in this role will help implement new claims system/configure provider contracts in new system (Tapestry).  In addition, they configure both professional and facility utilizing CPT/HCPCS and Revenue procedure coding. Interpreting/analysing provider facility contracts and configuring the system to ensure accurate claims payment, problem resolution, claim testing of provider configuration, manipulate provider data on spreadsheets used for importing.

Essential Functions:

Includes all responsibilities of the Configuration Analyst & Configures Both: Professional & Institutional Providers Provides technical coding & design advice for benefit development in support of product initiatives so that applicable PDMP approval gates or similar approval gates are met & the project plan remains on track (green) status.

Provides expert knowledge, impact analysis & recommendations related to configuration design & understanding impacts of provider contract data on all systems that require provider contract data & frequently act as a liaison, problem solver & facilitator.

Creates and/or socializes coding definitions. This work includes tools for project governance, tools & templates, protocols, engagement strategy, escalation protocols, decision-making, risk management & contingency planning.

Develops processes to analyze, design, configure, code & QA detailed provider designs & provides assistance to all departments .

Ensures correct interpretation & definition of contracts.

Identifies & seeks approval for key actions necessary to remediate all problems/issues & makes recommendations to management on steps to ensure product is delivered on time within specifications.

Reviews, creates & incorporates policies & procedures to implement coding best practices & makes recommendations to management on Regional or Program needs to achieve strategic objectives.

Develops & present recommendations & findings to departmental management & cross-functional leadership.

Maintains detailed knowledge & understanding of the host Claims processing system rules relative to claims payment.

Conducts research & resolution of debarred & sanctioned providers & communicate required system updates to Provider Contracting & Claims Operations.

This job description is not all encompassing.

Experience

Minimum five (5) years of experience in health care or managed care or equivalent education/experience such as in claims adjudication with knowledge of at least one of the following: membership, benefits, provider contracts & pricing, medical reviews, referral authorizations and code review and fee schedules.

Minimum three (3) years of experience as configuration analyst.

Significant experience in documentation, research and reporting.

Education

Bachelor's degree in information systems, business or health care administration, or other related field OR a minimum four (4) years of experience in a directly related field.

High school diploma or GED.

License, Certification, Registration

Certification in Tapestry in Core and either AP or Benefits Modules within six (6) months of hire.

Additional Requirements:

Demonstrated intermediate competency in medical coding, medical terminology, claims processing, logical thinking and understanding of relational database is required.

Knowledge of state and federal regulations

Strong critical thinking and analysis skills; verbal and written communications, and interpersonal interactions (eg partnering, conflict management, consulting, etc.).

Advanced proficiency in MS Office Suite of products.

Thorough understanding of relational databases.

Excellent interpersonal, communication, and listening skills are required.

Complete understanding and application of principles, concepts, practices, and standards.

Advanced knowledge in healthcare provider contracts and health care delivery from either/both a payor or provider perspective, EDI and paper claim life cycle, along with health insurance industry practices and standards.

Maintains current knowledge of performance tracking and quality improvement literature, and research projects.

Preferred Qualifications:

Certification in other Tapestry modules in addition to Core, AP and Benefits preferred.

Basis proficiency in Statistical analysis preferred.

Knowledge of Certification/Accreditation Standards (NCQA, JCAHO, CMS, etc.) preferred.

Knowledge of Internal processes preferred.

Knowledge of Epic Tapestry Modules preferred.

Start date
July 21, 2014
Duration
6 months
From
Enclipse Corp.
Published at
10.07.2014
Project ID:
739702
Contract type
Freelance
To apply to this project you must log in.
Register