Configuration Quality Assurance Analyst II

Partnership HealthPlan of California•Fairfield, CA

About The Position

The Configuration Quality Assurance Analyst II is responsible for auditing Configuration staff up to Analyst II functions on system related functions. Performs retrospective, concurrent, and special claims audits on assigned configuration projects. Completes audit documentation and reports. Collaborates with Technical Development and Quality Assurance teams to identifying trends for training purposes. Performs all activities related to auditing, tracking and documenting staff performance of operational processes for the Configuration department. Provides feedback and recommendations to the Configuration leadership team on trends and staff training.

Requirements

Bachelor’s degree in related field preferred. Experience with claims payment, claims editing and/or authorization management systems, fee schedules, and procedure/diagnosis code tables preferred. Prior trainingand/or auditing experience desirable. Minimum five (5) years of healthcare experience preferably in a managed care environment; or equivalent combination of education and experience.
Knowledge of claims payment, claims editing and/or authorization management systems preferred. Knowledge of managed care concepts, policies, and procedures. Ability to understand, interpret, and applyknowledge of regulatory requirements. Ability to quickly acquire in-depth knowledge of Partnership systems, software, applications, processes, and managed care issues. Working knowledge of MS Windows related applications and experience with database applications, typing, and 10-key use.
Strong written and oral communication skills with ability to interpret and understand technical requirements. Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy. Ability to work on multiple tasks withinestablished time frames and sometimes conflicting priorities. Good organizational skills with ability to maintain accurate records and documentation of actions and decisions.
Ability to use a computer keyboard. More than 60% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 10 lbs.
Provide the highest possible level of service to clients;
Promote teamwork and cooperative effort among employees;
Maintain safe practices; and
Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

Responsibilities

In collaboration with Configuration management team, Senior Configuration Analysts, Project Management, Technical Development, and Quality Assurance teams to identify audit trends and staff training needs
Perform monthly retrospective audits of Configuration staff up to Configuration Analyst II functions
Perform concurrent audits of Configuration staff up to Configuration Analyst II functions
Document audits and report all audit outcomes for Configuration management review
Writes and/or provides input on Configuration department procedures
Maintain current knowledge of assigned configuration areas of responsibility, and related Partnership Policy and Procedure, Medi-Cal Provider Manual, Title 22 regulations, CMS Medicare regulations, and Knox Keene regulations
Maintain current knowledge of all Partnership processes that impact Configuration department responsibilities Including but not limited to Claims, Member Services, Finance, Pharmacy, Health Services, Provider Relations, IT-EDI, IT-Amisys. IT-Webteam processes
Support design and enhancement to Configuration audit process
Support configuration related testing activities
Support configuration related project activities
Other duties as assigned.