Benefit Configuration Analyst

Parkland Health • Dallas, TX

91d

About The Position

The Analyst - Benefit Configuration (QNXT) ensures the accurate and timely setup and maintenance of benefits, contracts, and other critical configurations in the QNXT system. This role supports the health plan's operational and regulatory requirements by aligning system configurations with business rules and compliance standards.

Requirements

• Associate degree in business administration or related discipline required.
• Bachelor's degree preferred.
• Three years of QNXT or other claims system configuration experience required.
• Experience with QNXT preferred.
• Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines.
• Ability to communicate complex information in understandable terms.
• Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization.
• Excellent analytical and problem-solving skills.
• In-depth knowledge of QNXT system configuration modules, including benefits, contracting, and fee schedule setup.
• Ability to interpret and implement business rules within claims system configurations.
• Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities.
• Ability to write clearly and succinctly with a high level of attention to detail.
• Proficient computer and Microsoft Office skills. Ability to learn new software programs.
• Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.

Responsibilities

• Accurately configure and maintain benefits, contracts, prior authorizations, and fee schedules in QNXT to meet business and compliance needs.
• Accurately interprets specific state and/or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters.
• Work closely with the Configuration Manager to implement system updates, resolve challenges, and ensure smooth operational processes.
• Partner with teams such as Claims, IT, Provider Data Management, and Operations to gather requirements, troubleshoot issues, optimize workflows, maintain system integrity, validate configurations, and implement process improvements.
• Document configuration changes and create user-friendly documentation for future reference.
• Integrate health literacy principles into all communication including Members and Providers.
• Support strategies that meet clinical, quality and network improvement goals.
• Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed.
• For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination.
• Troubleshoot and resolve configuration-related issues in collaboration with internal teams.
• Perform thorough testing and validation of configurations to support UAT and ensure accurate claims adjudication.
• Identify risks related to configuration and propose solutions to mitigate errors.
• Monitor system performance and recommend enhancements to improve efficiency and accuracy in claims processing.
• Stay current on industry trends, Medicaid/CHIP policy updates, and QNXT system enhancements to implement best practices.
• Ensure work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements.
• Conduct regular audits to ensure system configurations align with operational requirements and regulatory standards.
• Ensure compliance with Texas Medicaid/CHIP regulations, NCQA standards, and organizational policies.
• Promote and support a culturally welcoming and inclusive work environment.
• Act with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
• Adhere to organizational policies, procedures, and guidelines.
• Complete assigned training, self-appraisal, and annual health requirements timely.
• Adhere to hybrid work schedule requirements.
• Attend required meetings and town halls.
• Recognize and communicate ethical and legal concerns through the established channels of communication.
• Demonstrate accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
• Maintain confidentiality at all times.
• Perform other work as requested that is reasonably related to the employee's position, qualifications, and competencies.

What This Job Offers

• Industry: Hospitals
• Education Level: Associate degree