Senior IT Configuration Analyst- Claims *HEALTHCARE

Phycians Medical Group /Excel MSO - San Jose, CA

Full-time

SUMMARY

Under minimal direction, The Sr. IT Configuration Analyst analyzes health plan and provider contracts, documents and implements system requirements, and maintains our core claims and utilization management system at Excel MSO and Physicians Medical Group of San Jose. This includes supporting configuration by way of requirements gathering from various stakeholders, system design and implementation, quality and functional testing, maintaining documentation, and project management.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Analyzes and translates fee schedules, contract terms, benefits, and provider data into system configuration parameters
  • Participates in business requirements analysis, development, and solution design process upon implementation of new requirements, clients, and/or products
  • Documents business requirements, develops configuration requirements, and maintains detailed documentation
  • Designs and executes system tests (unit, integration, regression), analyzes, and reports defects
  • Maintains system CPT, HCPC, ICD10 master code sets
  • Identifies and analyzes regular rate, benefit, and contract changes made by health plans, CMS and/or Medi-Cal
  • Troubleshoots core system configuration issues
  • Liaison with various internal and external stakeholders;
  • Submits work orders for system vendor review;
  • Ensures compliance with all health plan delegated policies for accurate configuration design;
  • Maintains current and develops new policies & procedures
  • Provides testing support to other departments
  • Assists with project work plan, assign task, workflow, and schedule to drive to completion
  • Communicates effectively both orally and in written for technical and non-technical audiences
  • Maintains confidentiality and complies with Health Insurance Portability and Accountability Act
  • Other duties and projects as assigned

EDUCATION REQUIREMENTS

  • Bachelor’s degree required. Preferred majors include Business Administration, Healthcare Management, and Computer Science. MBA a plus.QUALIFICATIONS AND EXPERIENCE

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  • Experience in the Healthcare industry, Financial Services, or Tech preferred
  • A minimum of two years experience in healthcare systems, configuration, claims processing, auditing or business analysis, is required
  • Claims auditing experience highly preferred
  • Experience working in a Health Plan, IPA, Medical Group, Managed Health Care, Medicare, or Medi-Cal environment preferred
  • Knowledge of claims payment, health care management systems, healthcare code sets, benefit plans, contracts, and fee schedule pricing methodologies preferred
  • Comprehensive knowledge of managed health care regulations and requirements – CMS, DMHC, DHCS a plus
  • Must possess strong analytical, problem-solving, project management and technical skills
  • Ability to establish and maintain good working relationships with staff, external clients, health plans, and government agencies, as necessary; demonstrates knowledge with Microsoft Office applications (Word, Excel, PowerPoint, Access, Outlook), Microsoft SQL and Visio knowledge highly desirable.
  • Startup and Fortune 100 experience preferred
  • Data analysis – Proficiency in Microsoft Excel required. Working knowledge of SQL required
  • SUPERVISORY RESPONSIBILITIES
  • No direct reports
  • Will lead projects

PHYSICAL DEMANDS

  • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
  • While performing the duties of this position, the employee is regularly required to sit and use hands to finger, handle, or feel objects, tools or controls. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to walk.
  • The employee must be able to lift and move up to 10 pounds. Specific vision abilities required by this position include close vision, color vision and the ability to adjust focus.
  • Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Job Type: Full-time

Salary: $75,000.00 to $90,000.00 /year

Experience:

  • Outlook: 4 years (Preferred)
  • Regulations: 2 years (Preferred)
  • Data Analysis: 3 years (Preferred)
  • CPT Coding: 2 years (Preferred)
  • Contracts: 2 years (Preferred)

Location:

  • San Jose, CA 95113 (Preferred)