Configuration Analyst I

Company: HealthOne Alliance
Location: Dalton
Posted on: March 20, 2023

Job Description:

The Configuration Analyst I supports activities to maintain data within the core claims processing system using the medical classification system to design the benefit packages with proper code sets, including ICD-10, CPT-4, HCPCS for configuration. Disseminates benefit determinations to key stakeholders administering benefits (health services, configurations, etc.) throughout the organization. Serves as an integral role in the testing, analysis and benefit configuration of new and existing plans.

Requirements

Duties and Responsibilities

• Assists with the dictionary/master file maintenance such as research, set up and maintenance of all Diagnosis, CPT and other medical code sets
• Assists with updates and maintains adjudication system with defined code sets in logical order
• Coordinates with internal departments to ensure data accuracy
• Supports maintenance of group/benefit additions, terms, changes
• Assists in the support fee schedule maintenance including terms, affiliations and contract maintenance
• Runs existing testing scripts for new and existing plans
• Assists in the on-going evaluation of the benefit configurations within the core claim processing system for new and existing benefit plans
• Documents the configuration of new plans as well as changes in existing plans
• Provides feedback to Configuration Analyst II regarding feasibility and requirements for enhancements to benefit configuration
• Provides research assistance for the resolutions of benefit issues
• Serves as a liaison of benefit configuration to external departments
• Collects and analyzes data to evaluate operational difficulties and makes recommendations to solve problems
• Supports the work to troubleshoot and resolves claims that suspend in work queues for configuration intervention in the claims processing system
• Audits files and/or batch load entries for accuracy
• Assists in problem solving of the monthly files such as 837 Encounter File submissions and error corrections
• Performs a variety of tasks related to the on-going maintenance and set up of client configurations with the core administrative system
• Assists with client implementations, system upgrades and projects to improve performance
• Participates in problem solving of provider, client, reporting or system issues
• Potential to rotate through configuration support functions across key system areas and lines of business with the ability to develop subject matter expertise
• Performs special projects as needed and other duties related to system and report data integrity
• Regular and predictable attendance
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
• Maintains work area in a clean and orderly condition and ensures safe operating conditions within area of responsibility
• Works to encourage and promote Company culture throughout the organization
• Other duties as may be assigned Qualifications
  • High School Diploma or GED required
  • Associates or Bachelor's degree in a business or computer-related field preferred
  • Knowledge of ICD-10, CPT4 Coding, HCPCS and medical terminology
  • Three or more years of Healthcare experience
  • Three or more years of working around claims implementation and analysis and/or claims configuration experience in any one of these areas: Provider/Provider Contracting, Clinical Benefits, Enrollment and Billing
  • Coding Certificate preferred
  • Proficiency in Microsoft Office Suite including Outlook, Word, Excel, and PowerPoint Competencies
    • Ethics - Honest, accountable, maintains confidentiality
    • Reliability - The extent to which the employee can be depended upon to be available for work, do it properly, and complete it on time. The degree to which the employee is reliable, trustworthy, and persistent.
    • Sense of Urgency - Meets deadlines, establishes appropriate priority, gets the job done in a timely manner
    • Computer Skills - Skilled with computers, takes advantage of new technology, learns new tools quickly, uses technology to enhance job performance
    • Decision Making - Able to reach decisions, takes thoughtful approach when considering options, seeks input from others, makes difficult decisions
    • Dependability - Completes job assignment and projects with minimal supervision. Meets schedules and deadlines.
    • Initiative - Takes action, seeks new opportunities, strives to see projects to completion
    • Job knowledge - Knowledge of products, policies and procedures; OR knowledge of techniques, skills, equipment, procedures, and materials
    • Planning & Organizing - Displays ability to effectively plan, organize and implement applicable tasks or projects in relation to established goals and objectives
    • Quality - Strives to eliminate errors, accurate work is a priority, seeks opportunities to improve product/services
      
      Physical, Mental, Environmental & Working Conditions
      
      Moderate amount of walking, sitting, and writing. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day events in the execution of job duties. Needs flexibility and adaptability to change. Candidate must be self-disciplined and a self-starter and able to work independently with a flexible work schedule. Must be able to drive a vehicle and daytime/overnight travel as required.

Keywords: HealthOne Alliance, Chattanooga , Configuration Analyst I, Professions , Dalton, Tennessee