Configuration Analyst

Independent Living Systems • Miami, FL, US, FL

12h

About The Position

The Configuration Analyst ensures healthcare software systems and applications are configured accurately to meet organizational needs and regulatory requirements. The role analyzes system configurations, identifies areas for improvement, and implements changes to enhance operational efficiency and data integrity. Working closely with clinical, administrative, and IT teams, the analyst tailors configurations to support member care workflows and compliance standards. The role also maintains detailed documentation and performs rigorous testing so system updates and new implementations function effectively in the healthcare environment, contributing to the technology infrastructure that supports clinical and administrative processes.

Requirements

• High school diploma or GED required; relevant education may substitute for the educational requirement on a year-for-year basis.
• At least two years of experience as a medical Senior Claim Examiner, Call Center Advocate, Business Analyst, or Trainer.
• Knowledge of UB04/CMS1500 claims; ICD-10, revenue, CPT, and HCPCS diagnosis and procedure coding; claim adjudication processes; EDI and OCR claim submission; and Medicare and Medicaid reimbursement methodologies, including APR DRG, Exempt Units, APG, RBRVS, and APC.
• Ability to analyze data and summarize it effectively, efficiently, and in an organized, professional manner.
• Ability to read and interpret contracts and related documents.
• Ability to work in a fast-paced environment, prioritize workloads, and multitask to complete projects on time.
• Excellent verbal, written, and presentation skills.
• Proficiency in Microsoft Office, including Word, Excel, PowerPoint, and Access.

Nice To Haves

• Associate's degree in healthcare or a related field.
• Knowledge of UB04/CMS1500 claims, ICD-10, revenue, CPT, and HCPCS diagnosis and procedure coding, claim adjudication processes, and EDI and OCR claim submission.
• Certification in Health IT or a related field, such as Certified Professional in Healthcare Information and Management Systems (CPHIMS).
• Knowledge of data analytics and reporting tools used in healthcare settings.
• Familiarity with project management methodologies and tools.
• Experience training and supporting end users in healthcare technology environments.

Responsibilities

• Test and process claims, including claim adjustments, and provide staff support and education as needed.
• Troubleshoot and resolve provider records to support claims operations.
• Process claims in accordance with corporate policies and procedures and state regulations.
• Review and analyze claim samples, including auto-adjudicated claims, to verify pricing against contractual agreements, negotiated rates, or Medicaid and Medicare rates.
• Provide timely and consistent feedback to management, both individually and collectively.
• Participate in ad-hoc projects as necessary.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED