Configuration Analyst

Configuration Analyst

Pride Health is hiring a Configuration Analyst to support our client’s medical facility based in Texas.

This is a 3-month contract with the possibility of an extension with competitive pay and benefits and a great way to start working with a top-tier healthcare organization This is a Hybrid Opportunity.

Location – Bellaire, Texas (77401)

Length of Assignment – 3 Months (Possibility of Extension)

Pay Range - $35 - $45 an hour

Shift and Schedule - Monday-Friday 8 am-5 pm (Hybrid)

Job Summary

• The configuration analyst should have strong knowledge in at least one of the areas under the purview of Med Policy
• Configuration: benefits, contracting, coding, fees schedules, or claim edits (CES).
• The Configuration Analyst role is responsible for the activities related to system updates, new health plan implementations, and conversions within Business Operations. Designs configuration solutions to meet new business requirements and performs updates for benefits, coding, contracts, fee schedules, or claim editing rules in adherence with business policies and state requirements.

Job Duties

• Analyzes incoming requests and designs configuration solutions to meet business requirements.
• Performs configuration changes for coding, contracts, benefits, fee schedules, and claim editing rules as needed.
• Creates testing scenarios to demonstrate the efficiency of proposed configuration solutions.
• Maintains thorough and concise documentation for tracking of all contracts, benefits, fee schedules, and claim editing rule changes related to Change Control Management or issues for quality audit purposes.
• Executes configuration changes in an accurate and timely manner to meet the department’s standards for quality and service level agreements.
• Assists with the development of configuration standards and best practices.
• Identifies claims impacted by configuration changes done in the system and sends reports to the claims administration department for reprocessing.
• Monitors pending claims and work queues to update appropriate systems. Responsible for escalating identified issues, making recommendations, and assisting with implementing configuration changes to improve the accuracy and efficiency of the process
• Handles fluctuating volumes of work and prioritizes work to meet deadlines and user needs of the Health Plan.

Requirements

• Required- H.S. Diploma or GED
• Preferred - Bachelor's degree
• Required- 2 years in Managed care, claims processing, and/or configuration of benefits/contracts/fee schedules/medical policy payment rules.
• From a technical perspective, it would be ideal if they have experience with the following three buckets
• Experience in Texas Medicaid
• Claims Specialist or Claims Research Analyst experience
• Specifically, experience working on adjustments/appeals
• Tapestry Benefits or Tapestry Contracts Configuration Experience.
• Tapestry Certifications in Contracts or Benefits.
• Knowledge of current managed care business practices and adjudication systems used by the Health Plan.
• A working knowledge of the healthcare industry, preferably health insurance/managed care.
• Collaboration, written and verbal communication, detailed analytical and organizational skills; ability to manage time with competing priorities; self-motivation; leadership; and ability to work independently with minimum supervision.
• Additional required knowledge includes claims processing, configuration of contracts, benefits, fee schedules, and Claims
• Editing System; ability to interpret business requirements into system coding edits, and testing of configuration builds.
• At least one EPIC Tapestry certification is strongly preferred.

Benefits

Pride Global offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

Equal Opportunity Employer

As a certified minority-owned business, Pride Global and its affiliates - including Russell Tobin, Pride Health, and Pride Now - are committed to creating a diverse environment and are proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.