Configuration Systems Analyst III - CES

CareSource•Texas WFH, TX

1d•$83,000 - $132,800•Onsite

About The Position

The Configuration Systems Analyst III is responsible for managing and defining system configuration requirements. This role involves managing and defining system configuration requirements, including responsibility for requirements, definition, documentation, design, testing, training, and implementation support using appropriate templates or analysis tools. The analyst will develop and utilize reports to analyze and stratify data to address gaps and provide answers to issues identified within the department or by other departments. They will identify, manage, and document the status of open issues, configuration design, and final resolution within the change management system. The role also includes reviewing and interpreting regulatory items, timely delivery of required updates, development of standard code set and reimbursement design templates, and planning and implementing new software releases including testing and training. Additionally, the Configuration Systems Analyst III will participate in meetings with business owners, users, and IT to achieve solutions, lead configuration initiatives in payment policy meetings, present to committees, and coordinate annual benefit changes with internal resources. The position involves providing analysis of efficiencies related to system enhancement and automation, reviewing, analyzing, and documenting the effectiveness and efficiency of existing systems, and developing strategies for improving or further leveraging systems. The analyst will manage the reimbursement review, identify and design appropriate changes, and lead the development and execution of test plans and scenarios for all reimbursement designs for core business systems and related processes. Auditing configuration for accuracy and internal controls to minimize fraud, abuse, and overpayment issues is also a key responsibility. The role requires anticipating and identifying customer needs and matching products and services to facilitate their fulfillment, ensuring system processes and documents exist as a basis for system logic, and managing resources and communications to facilitate work completion. Mentoring the use of tools to define requirements and performing any other requested job duties are also part of the role.

Requirements

High School Diploma or GED is required
A minimum of five (5) years of health plan experience, to include three (3) years of configuration or clinical editing software experience is required
Exceptional computer skills and abilities in Facets
Advanced proficiency Microsoft Suite to include Word, Excel, Access and Visio
Proven understanding of database relationships required
Understanding of DRG and APC reimbursement methods
Understanding of CPT, HCPCs and ICD-CM Codes
Knowledge of HIPAA Transaction Codes
Effective listening and critical thinking skills
Effective problem solving skills with attention to detail
Excellent written and verbal communication skills
Ability to work independently and within a team environment
Strong interpersonal skills and high level of professionalism
Ability to develop, prioritize and accomplish goals
Understanding of the healthcare field and knowledge of Medicaid and Medicare
Proper medical coding knowledge and claims processing skills
Customer service oriented
Ability to manage vendor relationships

Nice To Haves

Bachelor’s degree or equivalent years of relevant work experience is preferred
Exposure to Facets or equivalent system is preferred
Facets knowledge/training

Responsibilities

Manage and define system configuration requirements.
Responsibility for requirements, definition, document, design, testing, training and implementation support using appropriate templates or analysis tool
Develop and utilize reports to analyze and stratify data in order to address gaps and provide answers to issues identified within the department or by other departments
Identify, manage and document the status of open issues, configuration design, and final resolution within change management system
Review and interpret regulatory items, timely delivery of required updates
Development of standard code set and reimbursement design templates
Plan and implement new software releases including testing and training
Participate in meetings with business owners, users and IT to achieve solutions that meet the requirements and expectation of CareSource
Lead configuration initiatives in payment policy meetings and present to committees
Coordinate annual benefit changes with internal resources
Provide analysis of efficiencies related to system enhancement and automation.
Review, analyze, and document effectiveness and efficiency of existing systems and develop strategies for improving or further leveraging systems
Manage the reimbursement review. Identify and design appropriate changes.
Lead the development and execution of test plans and scenarios for all reimbursement designs for core business system and related processes
Audit configuration to ensure accuracy and internal controls to minimize fraud and abuse and overpayment related issues
Anticipate and identify customer needs and match products and services to facilitate the fulfillment of those needs
Ensure system processes and documents exist as basis for system logic
Manage resources and communications to facilitate work completion
Mentor the use of tools to define requirements
Perform any other job duties as requested