Configuration Analyst I

Health One Alliance•Dalton, GA

5d•Onsite

About The Position

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. This role disseminates benefit determinations to key stakeholders administering benefits (health services, configurations, etc.) throughout the organization. The Configuration Analyst I serves as an integral role in the testing, analysis, and benefit configuration of new and existing plans.

Requirements

High School Diploma or GED required
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

Nice To Haves

Associates or Bachelor's degree in a business or computer-related field preferred
Coding Certificate preferred
Proficiency in Microsoft Office Suite including Outlook, Word, Excel, and PowerPoint

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
Maintains regular and predictable attendance
Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
Works to encourage and promote Company culture throughout the organization
Other duties as may be assigned