Health Plan Configuration Analyst

Avera Health•Sioux Falls, SD

About The Position

The Avera Health Plan Configuration Analyst is responsible for the design, implementation, and support of the Epic Tapestry module, which manages health plan administration, benefits, fee schedules, claims, enrollment, care coordination, clinical/authorizations and provider data. This role ensures that managed care workflows are optimized and aligned with organizational goals, regulatory requirements, and member-centered care initiatives. As a Configuration Analyst you will work closely with clinical, operational, and technical stakeholders to translate complex business needs into efficient system solutions, while maintaining the integrity and performance of Epic applications.

Requirements

Bachelor's degree in Healthcare Administration, Information Systems, or related field or Epic Tapestry Certification with 3+ years of experience.
Epic Tapestry certification or required to participate in Epic coursework and pass certification exams within 90 days of hire.
Demonstrated critical thinking skills through evaluation, analysis, and creative solutions.
Ability to think broadly, identifying and understanding implications to the entire organization including excellent communication, documentation and problem-solving skills.
Ability to work independently and as part of a cross-functional team.

Nice To Haves

4-6 years Experience with complex system design, preferred experience with claims adjudication platforms or ecosystems, specifically Epic Tapestry.
Background and knowledge of Health Plan operations and understanding of health plan processes, systems and regulations including claims processing, benefit configuration, enrollment and provider networks. Including familiarity with CMS regulations, HIPAA and payer-provider contracting.
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
Experience with Epic Chronicles and data models, Care Management or other related modules.
Familiarity with EDI (Electronic Data Interchange) formats (e.g., 834, 837, 835) and integration best practices.
Professional and/or facility coding familiarity.

Responsibilities

System Configuration & Optimization: Build, test, implement, and maintain Epic Tapestry components and functional workflows. Converting benefit plan requirements into system configurations, collaborating with other analysts and business leaders, ensuring data accuracy, customizing settings to support payer-provider relationships and supporting the system's ongoing performance. Develop and improve workflows and business processes to improve customer service, decrease operational administrative costs, and improve overall health plan outcomes and quality. Collaborate with Epic and internal teams to implement and test new features and enhancements on a quarterly basis.
System Support & Troubleshooting: Provide support for Epic Tapestry-related issues, including performing root-cause analysis, resolution, documentation of results and present business impact analysis for proposed configuration changes. Monitor existing system performance and make configuration recommendations, where appropriate, to maintain acceptable levels of automation in claims adjudication and member enrollment, workflows and accurate claims payment.
Stakeholder Collaboration: Partner with internal teams, including health plan business and functional operations teams, Avera system stakeholders for other Epic applications and IT staff, to ensure accurate and compliant system configurations. Work closely with operational teams to interpret functional operating procedures and align system capabilities with operational goals. Provide input on system design to improve efficiency and reduce administrative burden. Collaborate with data integration and reporting teams to ensure data consistency and performance.
Requirement Analysis: Uses experience and judgement to plan and accomplish goals; performs a variety of complicated tasks to ensure that the core claims system is configured correctly by reviewing the system components and validating that the configuration aligns to legal plan documents and regulatory requirements. Interpret and analyze plan documents, such as Evidence of Coverage (EOCs), fee or rate schedules, policies, code set changes and translate into technical specifications for the system.
Data management: Provides analysis and documentation that supports configuration management, design, requirements traceability, and audit controls needed to meet state and federal regulatory requirements. Work with Epic Chronicles and data models, and understand relevant EDI (Electronic Data Interchange) formats like 834, 837, and 835.