Configuration Analyst

Job Summary

We are searching for a Configuration Analyst -- someone who works well in a fast-paced setting. In this position, you will be responsible for the activities related to system updates, new health plan implementations, and conversions within Business Operations. Designs configurations solutions to meet new business requirements and perform updates for either benefit, coding, contracts, fee schedules, or claim editing rules in adherence with business policies and state requirements. 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).

Responsibilities

Responsibility A: Performs daily configuration changes in claim adjudication systems

* 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 pended 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 processes
* Handles fluctuating volumes of work and prioritizes work to meet deadlines and user needs of the Health Plan.

Responsibility B: Performs system configuration design analysis associated with projects

* On receipt of a service ticket, analyze the request, and solution for the resolution
* Shares the solution with the Lead Configuration Analyst for feedback and approval
* Applies knowledge and experience to ensure all appropriate requirements have been provided
* Collaborate with the other team members to ensure that the documentation of user policies and procedures is updated timely as changes may occur
* Partner with end-users to determine specific requirements needed to increase configuration accuracy

Responsibility C: Analyzes configuration errors and identifies required modifications

* Analyzes current configuration to identify and resolve errors
* Recommends modifications to configuration settings or current procedures to improve claims adjudication
* Documents issues, activities, and solutions employing standard methodology and utilities.

Responsibility D: Supports new system implementations and upgrades Assist departmental leaders with upgrade testing as needed

* Communicates with management to address problems and resolutions
* Participates in training sessions with users to view new systems and upgrades
* Reviews and tests systems for conformance to functional and performance requirements

Qualifications

* Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children's unless approved for a medical or religious exemption.
* Required H.S. Diploma or GED with a preferred Bachelor's Degree
* 2 years Managed care, claims processing, and/or configuration of benefits/contracts/fee schedules/medical policy payment rules experience

Company Profile

Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 14,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org. At Texas Children's Hospital, diversity, equity, and inclusion are at the core of our values and mission for the families that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.