Configuration Analyst

Independent Living Systems • FL

114d

About The Position

The Configuration Analyst in the Health Care Services industry plays a critical role in ensuring that healthcare software systems and applications are accurately configured to meet organizational needs and regulatory requirements. This position involves analyzing system configurations, identifying areas for improvement, and implementing changes that enhance operational efficiency and data integrity. The analyst collaborates closely with clinical, administrative, and IT teams to tailor configurations that support member care workflows and compliance standards. By maintaining detailed documentation and performing rigorous testing, the Configuration Analyst ensures that system updates and new implementations function seamlessly within the healthcare environment. Ultimately, this role contributes to the delivery of high-quality healthcare services by optimizing the technological infrastructure that supports clinical and administrative processes.

Requirements

• High School diploma or GED required.
• Minimum two (2) years' experience as a medical Senior Claim Examiner, Call Center Advocate, Business Analyst or Trainer.
• Knowledge of UB04 / CMS1500 claims, ICD-10 / Revenue / CPT / HCPCS diagnosis and procedure coding, claim adjudication processes, EDI and OCR claim submission.
• Medicare and Medicaid reimbursement methodologies including APR DRG / Exempt Units / APG / RBRVS / APC.
• Relevant experience may substitute for the educational requirement on a year-for-year basis.

Nice To Haves

• Associate's degree in health care or related fields.
• Certification in Health IT or related fields (e.g., 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 in training and supporting end-users in healthcare technology environments.

Responsibilities

• Claims testing and processing including claim adjustments, as well as providing support and education to the staff as necessary.
• Troubleshoot and resolve provider records to support the claims operation.
• Process claims in accordance with corporate policies and procedures and state regulations.
• Review and analyze a variety of claim samples including auto-adjudicated claims to assure pricing per contractual agreement, negotiated rate or to Medicaid and Medicare rates.
• Provide consistent feedback to Management in timely manner both individually and collectively.

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees