IS System Configuration Analyst II

CareOregon

About The Position

This position is responsible for providing system configuration for the organization’s managed care payment system (QNXT) and other core vendor developed systems at an intermediate level. Ensures system configuration consistency across all core applications, including technical scoping, configuration, testing, and implementation. Participates in the vendor management discipline, supporting long term vendor performance and strategy. Other core responsibilities include IS team and user collaboration, analysis, and documentation. Estimated Hiring Range: $72,765.00 - $88,935.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

Requirements

Minimum 3 years’ experience in system configuration or progressively responsible experience in areas that integrate with configurations such as claims processing, coding, auditing, billing, or encounter data
Advanced knowledge in some or all of the following areas: o Computer applications skills (claims payment, Excel, Word, Outlook) o Computer programming concepts and practices o Medicaid and Medicare benefit plans o ICD, CPT, HCPCS and other national coding systems o Claims operation practices and protocols o Principles and practices of managed care systems, procedures, and plan products/systems o System plan/benefit building and maintenance o HIPAA regulations and compliance o Computing/applying rate calculations, and resolving rate calculation disputes
Effective communication skills, including listening, verbal, written, and customer service
Ability to clearly articulate policies and instructions
Ability to exercise professionalism
Effective ability to network and utilize internal and external resources
Ability to convey appropriate level of detail to all levels of the organization including non-technical staff
Growing ability in simplifying and presenting complex concepts in an easily understood way
Ability to proactively and appropriately communicate status and needs
Ability to recommend policies, document risks, and propose solutions to information services management and senior leadership
Possess a high degree of initiative and motivation
Ability to lead teams of people with some oversight
Effective project management skills
Effective vendor management skills
Ability to produce high quality and timely results, with effective organizational skills
Effective analytical and research skills; demonstrated progress in seeing patterns in data and drawing appropriate conclusions
Basic creativity and innovation abilities
Ability to propose solutions and communicate business value

Nice To Haves

2 years’ experience in claims processing, coding, or auditing
1 year experience in health plan system (e.g., QNXT, Facets, Tapestry, etc.) or provider revenue system

Responsibilities

Configure and perform daily software maintenance with some management oversight to support the efficient administration and data integrity of multiple systems: o QNXT, including claims, utilization management, benefits, contracts, member, call tracking, fees and code modules o Optum Claims Edit System o CareOregon Connect provider and member web portal
Participate in objective decision making to maintain data integrity, alignment and usability of applications for multiple departments across the organization in line with organizational objectives.
Grow in identifying and articulating how the impact a configuration change has on upstream and downstream services and business workflows.
Assist leadership in governance, demonstrating progress learning how to evaluate and monitor applications to ensure they align with and sustain the objectives of the organization.
Participate in frontend and backend process testing and implementation of new software and software upgrades that supports the organization’s strategic goals.
Perform advanced quality assurance testing to validate configuration behavior against established baselines, in keeping with contract, regulations, and customer requirements.
Develop and maintain appropriate configuration documentation related to configuration and processes; participate in developing policies and procedures.
Collaborate with business teams to build accurate system process and training documentation for consistency with system configuration and workflows.
Collaborate with a variety of stakeholders with guidance from senior System Configuration Analysts or team manager.
Serve as the point of escalation following the service desk for users experiencing software functionality issues.
Assist operational departments with system functionality questions for current, new or emerging work.
Assist users in submitting comprehensive development and Change Control Board requests.
Assist software developers, production support, engineers and technicians with a variety of user, process and system needs, such as interpreting requirements for technical solutions and verifying deployed solutions meet the business need.
Support internal and external auditors to provide system configuration information.
Participate fully and constructively in department meetings, department decisions and department growth.
Participate as an advance resource in interdepartmental workgroups, such as the Change Control Board, cost and utilization committees, and payment integrity program.
Maintain impartiality and upholds the objectives of the organization.
Participate in software user groups, attend conferences to further education and establish relationships with peer organizations.
Conduct advanced research of software system enhancements and functionality.
Participate in assessing impact of system changes on the organization and interfacing systems.
Recommend software configuration that aligns with existing or new business requirements as identified by IS or operations teams.
Review and interpret provider contracts for accuracy and assess ability to administer.
Research and interpret CMS, OHA and federal and state regulations with manager guidance.
Retain knowledge and remain abreast of relevant State and Federal laws and regulations relating to the medical health insurance industry and the Medicare and Medicaid industry.
Consult with operational departments to determine needs and propose solutions in terms of system design and implementation.
Research and advise users on best practices of system utilization.
Identify situations where configuration alone cannot meet business requirements and participate with operational areas to develop supporting processes.
Submit detailed, concise system functionality incidents to software vendors using their service software.
Develop and maintain effective working relationship with vendors to communicate business needs, identify defects, and resolve system functionality gaps.
Monitor reported issues and escalate serious issues or delays to management.
Provision user security access for designated software applications following policies and procedures of CareOregon, vendor or business partners.
Understand software usage and user’s position responsibilities sufficiently to identify when access is not in keeping with HIPAA minimum necessary protocol.
Consult with manager regarding new and challenging access requests.
Conduct regular audits of user security audits.
Perform work in alignment with the organization’s mission, vision and values.
Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support of the organization’s strategic goals.
Adhere to the organization’s policies, procedures and other relevant compliance needs.
Perform other duties as needed.

Benefits

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package.
Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours.
Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date.
CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.).
We also offer a strong retirement plan with employer contributions.
Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state.
Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility.
Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks.

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