Configuration Systems Analyst III - CES

Job Summary:

The Configuration Systems Analyst III is responsible for managing and defining system configuration requirements.

Essential Functions:

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

Education and Experience:

• High School Diploma or GED is required
• Bachelor’s degree or equivalent years of relevant work experience is preferred
• A minimum of five (5) years of health plan experience, to include three (3) years of configuration or clinical editing software experience is required
• Exposure to Facets or equivalent system is preferred

Competencies, Knowledge and Skills:

• 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
• Facets knowledge/training
• Ability to manage vendor relationships

Licensure and Certification:

Certified Medical Coder (CPC) is preferred

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time