Senior Configuration Analyst

Parkland Health & Hospital System•Dallas, TX

28d•Hybrid

About The Position

The Senior Configuration Analyst is responsible for the precise and timely implementation and ongoing maintenance of benefits, contracts, rate sheets, fee schedules, and other essential configurations within the QNXT and NetworX systems. This role plays a critical part in supporting the health plan's operational and regulatory obligations by ensuring system configurations are aligned with established business rules and compliance standards.

Requirements

High School Diploma required.
Five (5) to Seven (7) years of QNXT or other claims system configuration experience required.
Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines. Ability to communicate complex information in understandable terms.
Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization.
Excellent analytical and problem-solving skills.
In-depth knowledge of QNXT and NetworX system configuration modules, including benefits, contracting, and fee schedule setup.
Ability to interpret and implement business rules within claims system configurations.
Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities.
Ability to write clearly and succinctly with a high level of attention to detail. Proficient computer and Microsoft Office skills. Ability to learn new software programs.
Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.

Nice To Haves

Associate degree in business administration or related discipline preferred.
Bachelor's degree in business administration or related discipline preferred.
Experience with QNXT and NetworX preferred.

Responsibilities

Trains staff on configuration functionality, enhancements, and updates.
Works with internal and external stakeholders to understand business objectives and processes.
Partner with teams such as Claims, IT, Provider Data Management, and Operations to ensure all end-to end business requirements have been documented.
Work closely with the Configuration Manager to implement system updates, resolve challenges, and ensure smooth operational processes.
Act as a delegate for the manager during meetings, providing leadership and addressing staff inquiries in the manager's absence to ensure continuity of operations
Oversee the SNOW tickets dashboard, assigning requests to staff based on role, complexity, and due date to ensure service level agreements (SLAs) are consistently met.
Accurately configure and maintain benefits, contracts, prior authorizations, and fee schedules in QNXT to meet business and compliance needs.
Accurately interprets specific state and/or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters.
Document configuration changes and create user-friendly documentation for future reference.
Integrate health literacy principles into all communication including Members and Providers.
Support strategies that meet clinical, quality and network improvement goals.
Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed.
For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination.
Troubleshoot and resolve configuration-related issues in collaboration with internal teams.
Perform thorough testing and validation of configurations to support UAT and ensure accurate claims adjudication.
Identify risks related to configuration and propose solutions to mitigate errors.
Monitor system performance and recommend enhancements to improve efficiency and accuracy in claims processing.
Stay current on industry trends, Medicaid/CHIP policy updates, and QNXT system enhancements to implement best practices.
Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements.
Conduct regular audits to ensure system configurations align with operational requirements and regulatory standards.
Ensure compliance with Texas Medicaid/CHIP regulations, NCQA standards, and organizational policies.
Promotes and supports a culturally welcoming and inclusive work environment.
Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
Adheres to organizational policies, procedures, and guidelines.
Completes assigned training, self-appraisal, and annual health requirements timely.
Adheres to hybrid work schedule requirements.
Attends required meetings and town halls.
Recognizes and communicates ethical and legal concerns through the established channels of communication.
Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
Maintains confidentiality at all times.
Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies.
Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.