Location: Minneapolis, MN
Duration: 3+ Months
- Three years of previous experience as a configuration analyst in a managed health care environment.
- One year of HealthRules Payor Configuration experience.
- Microsoft Office proficiency.
- Experience using Business Objects.
- Ability to build and maintain relationships across the enterprise.
- Strong knowledge of government programs, regulations and benefits.
- Previous experience with CMS, DHS or payer reimbursement methodologies and /or payment policies.
- Knowledge of or experience with Optum Claims Editing System (CES) and Axiom TranSend.
- Bachelor’s degree in business or health care; demonstrated work experience may be considered in lieu of degree.
- This position is responsible to design, configure, test, implement and maintain HealthRules Payor pricing, claims and/or benefit configuration, according to business requirements, to support accurate and efficient processing and data reporting.
- Investigate and resolve configuration-related provider, member and claim processing issues and assist other departments in understanding HealthRules Payor configuration.
- Develop and maintain an understanding of current HealthRules Payor configuration, contracts, products and policies.
- Configure, test, implement and maintain HealthRules Payor to support changes in contracts, legislation, and payment policies and procedures, ensuring timely maintenance & updates of configuration.
- Participate in review, impact assessment, testing and modifications for application updates, upgrades and installations.
- Assist in the development of test scenarios for changes and/or projects to ensure accuracy of configuration completed.
- Manage the timely resolution of open testing bugs and issues.
- Develop and monitor post production audit reports to ensure the intent of change and/or project requirements is being met.
- Develop and maintain configuration documentation and communicate changes, as appropriate.
- Document detailed functional requirements that support and align to business requirements and testing scenarios.
- Research and respond to service requests in a prompt and timely manner and update or build configuration in HealthRules Payor as needed.
- Recommend and assist in drafting new and updated procedures to maximize the use of HealthRules Payor and improve efficiency.
- Maintain departmental documentation on assigned projects and determine most effective methods to accomplish project goals.
- Keep Configuration Manager informed of issues and progress on projects.
- Provide ad hoc and standard analyses upon request to support specific projects or project requests.
- Develop and maintain good working relationships with the staff of other departments including Provider Relations & Contracting, Healthcare Economics, Provider Assistance Center, Government Relations, Product, and Coverage Policy.
- Participate on internal committees as assigned by Manager.
- Research and recommend methods to improve or implement necessary changes in a prompt and efficient manner.
- Other project and duties as assigned.