Lead Business Configuration Solutions Analyst

Lead Business Configuration Solutions Analyst Position Summary : The Lead Business Configuration Solutions Analyst is a highly visible, self-directed position, with exposure to all levels of management with responsibility for analysis, design, build and testing of provider contract arrangements and benefit plans within claim adjudication platform to ensure accurate and timely claims payment.

This position will provide configuration thought leadership to organization and participate in the development of end-to-end configuration and maintenance solutions to provide optimization support for the Configuration Team by partnering with business teams, analytics, and vendors.

The Lead will have input into the design of the core claims adjudication platform and work cross functionally within MedCost and applicable vendor on configuration strategies.

The Lead will use knowledge and experience in the hierarchy of system, business rules, and integration to determine downstream impacts to other applications and file feeds as part of configuration design.

This position will be responsible for managing configuration projects across functional areas. The Lead supports the team by providing knowledge transfer and configuration guidance. Position Responsibilities :

Participate in the development of innovative configuration designs to support unique client requests with minimal custom coding.

Provide recommendations on design of new system logic to support new legislation, medical policy updates, and reimbursement methodology changes.

• Provide guidance and support to Configuration Analysts to implement best practices in configuration that generate higher return on investment and an optimized workflow.
• Collaborate cross functionally to develop, implement, and maintain scalable configuration arrangements to ensure maximum reusability across standard product offerings to enable standardization, simplification, and accuracy.

Continually assess system configuration capability against long term business needs.

Translates configuration rules, fee schedules, contract terms, provider data, code sets and benefits into system parameters to support accurate downstream operations for enrollment, billing, and claims processing.

Stays up to date on all MedCost plan contracts, amendments, and fee schedule updates.

Create project plans, documentation, and metrics to monitor the progress of configuration projects when needed. Identifies barriers and issues throughout project to ensure timely and successful project completion.

Manage cross functional stakeholder expectations and relationships to ensure success

• Leads business requirements development and solution design which may include facilitating sessions with business owners and other team members for new business, renewal changes, or
• Maintain and support professional and facility reimbursement. Stay current on all types of reimbursement methodologies and changing industry standards.
• Create, review, and deliver documentation regarding configuration details and processes (user guide, process flow charts, and training materials)
• Represents the Configuration Team on corporate projects as assigned.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.

Duties, responsibilities and activities may change at any time with or without notice. Position Qualifications : Required

• BA / BS in healthcare management, business, economics, or related field from an accredited college or university and 4+ years’ experience in a configuration function, knowledgeable about configuration best practices and methodologies with HealthRules, Facets, Diamond, Amisys or similar payer system
• In lieu of a degree, 8+ years’ experience in a configuration function, knowledgeable about configuration best practices and methodologies with HealthRules, Facets, Diamond, Amisys or similar payer system
• Strong project management skills

Preferred

• Experience with a TPA or healthcare industry
• Working knowledge and understanding of CMS policies and procedures
• Experience working on an agile team

Skills, Knowledge and Abilities

• Experience in plan building, provider data maintenance and reimbursement methodologies
• Problem solving, critical thinking, and process analysis skills
• Working knowledge of health care operations such as authorizations, benefits, enrollment, provider contracting, and claims adjudication
• Excellent written, verbal, and presentation skills to convey complex ideas, concepts, and applications.
• Experience in data analysis, testing and implementation
• Proficiency in Healthcare and Health Plan terminology, medical coding (e.g., CPT, HCPCS, ICD10, DRG)
• Excellent interpersonal skills, including the ability to work collaboratively across the organization
• Experience in managing projects across multiple departments or leading cross functional teams in a fast-paced work environment
• Proficient in Microsoft Office Suite Word, Excel, PowerPoint, Outlook, SharePoint

MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees.

E-Verify is an internet-based program that compares information from an employee's Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility.

MedCost does not use E-Verify to pre-screen job applicants.