Analyst II

5 months ago

Rancho Cucamonga CA United States Inland Empire Health Plan Full time
What you can expect

Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience

Under the direction of the Supervisor of Product System Configuration, the Analyst II – Product System Configuration is responsible for managing the more complex system configurations within the Business System. The primary functions of this position include but are not limited to, accurate interpretation of state, federal, and contractual guidelines related to benefits, fee schedules, contracts, division of financial responsibility (DOFR), codification of services, and business requirements and translating them into configurable parameters within the Business Systems. The Analyst II – Product System Configuration is independent and acts as a subject matter expert for the business areas by helping to drive decisions related to system configuration. The incumbent will develop and maintain comprehensive documentation of business and technical specification requirements utilizing best practice configuration guidelines developed by the Application Architects within the unit. The Analyst II – Product System Configuration will facilitate communication and formally report findings to various department heads and staff in a manner that is appropriate to the skill level and technical expertise of the audience. This position will be required to train and help educate other team members within the unit as necessary.

Major Functions (Duties and Responsibilities)

1. Assist with the development of configuration standards and best practice guides for maintaining efficiency, accuracy, automation and successful integration with internal and external systems and programs.
2. Analyze and translate business specifications into detailed technical specifications based on system functionality and develop non-systematic workaround processes when necessary.
3. Perform product system error root cause analysis.
4. Track incoming requests and issue resolution through Microsoft Access, MediTrac, and Workfront tools.
5. Identify and communicate impact of system enhancements or configuration changes on integrated systems and processes.
6. Monitor and work daily System Configuration inventory and ensure compliance with established service level agreements and regulatory timelines.
7. Configure and maintain complex product related system builds with multi-tiered functionality and interrelated system dependencies, including but not limited to Contracts, Benefits, Fee Schedules, and Service Categories.
8. Assist Contracting team with drafting appropriate contract fee schedule language to be in line with system adjudication capabilities and coding standards.
9. Develop and maintain business requirements for the automation of coding updates.
10. Track, test, and approve new system functionality, enhancements, and bug fixes, including the development and execution of test plans and scripts.
11. Perform weekly/bi-weekly audit of check run products to proactively identify potential system configuration issues before products are released.
12. Other duties as assigned, including but not limited to Department Projects and LEAN/A3 Events.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

CalPERS retirement
457(b) option with a contribution match
Generous paid time off- vacation, holidays, sick
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Paid life insurance for employees with additional options
Short-term, and long-term disability options
Pet care insurance
Flexible Spending Account – Health Care/Childcare
Wellness programs that promote a healthy work-life balance
Career advancement opportunities and professional development
Competitive salary with annual merit increase
Team bonus opportunities

Education & Experience

Four (4) years of experience with the development and remediation of moderately complex system configurations, including capitated provider agreement configurations
Bachelor’s degree from an accredited institution required
In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position
two (2) years of general healthcare experience plus two (2) years of configuration experience is required

Key Qualifications

Knowledge of Medicare and Medi-Cal fee schedules and benefit structure, and regulatory billing guidelines required
Knowledge of CMS, DHCS, DMHC, NCQA rules and regulations preferred
Extensive knowledge of CPT, HCPCS, Revenue, ICD10 coding rules and guidelines preferred
Extensive knowledge of general managed care operations required; delegated plan model preferred
Basic knowledge of relational database structure
Advanced knowledge of Product System algorithms and processes preferred
Familiar with basic medical product processing preferred

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