Description
52307-Configuration Analyst
Rockville, MD 20852
Position type: w2
Contact duration: 6months + (Strong Possibility of Extension)
Purpose and Description:
Analyst is responsible for the management and maintenance of Benefit configuration in the BETS, HealthConnect, KMATE, and Diamond Claims system to support accurate and timely payment or adjudication of claims, benefit administration (such as: Member out of pocket maximums) and EOC production and generation.
Essential Functions:
Ensures the accurate translation of the benefits to the Book Logic Table for accurate production of the EOC and Group Agreements
Ensures benefit information is translated from source documents to the BETS system so accurate benefit configuration is available in supporting systems
Ensures configuration accuracy meets or exceeds Regional metrics
Is responsible for maintaining integrity of BETS, HealthConnect, KMATE, DIAMOND benefit information and other systems as applicable
Ensures benefit configuration meets established business rules and procedures
Develops and executes test plans for configuration testing, reports on outcome
Acts as liaison between Contract Benefit Configuration and other departments regarding system configuration and functionality
Modifies the systems: BETS, HealthConnect, KMATE, DIAMOND, and other systems as applicable configuration to reflect source documentation.
Ensures that deliverables produced meet quality, cost, and turnaround metrics
Consults with relevant department to determine appropriate interpretation and configuration of benefit information
Ensures effective coordination of work activities and objectives with others
Validates that the completion of administrative requirements is met in a timely and accurate manner
Maintains detailed knowledge and understanding of benefit configuration in all systems
Performs problem resolution of configuration issues
Escalates concerns, issues or discrepancies to management team
Responsible for peer-to-peer quality assurance support and oversight
Required Experience:
.*These are the MUST HAVE items. If a candidate does not have these then they will be rejected*
3 years of experience in business process redesign in a health care environment.
High Intermediate to Expert level knowledge and experience using Microsoft Excel..*this MUST be tested and a SCREENSHOT of the results MUST be attached at the bottom of the resume. Without that the candidate will be rejected.*
Familiarity with remaining applications in the Microsoft Suite (Word, Access, and PowerPoint) and Visio
.Preferred Experience:
.*These are things that we would like to see, but are NOT required to fill the position. These are NOT disqualifying items*
Lotus Notes experience
Project Coordination experience.
Experience in reporting tools (Project)
Experience in database management.
Managed Care experience
Required Education:
.Bachelor's Degree, preferably in Health Care Administration, Business Administration or a Health Profession, or equivalent (Additional four years) combination of education and work experience in healthcare, preferably in an HMO setting
Skills to be successful in this role:
Managed Care experience preferred.
Working knowledge of KMATE, BETS, DIAMOND, KPHC configurations
Understanding of detailed spreadsheet knowledge is required.
Excellent communications and technical writing skills are required.
Personal computer literary is required.
Team orientation required.