Analyst II - Product System Configuration
: Job Details :

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.PerksIEHP 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 retirement457(b) option with a contribution matchGenerous paid time off- vacation, holidays, sickState of the art fitness center on-siteMedical Insurance with Dental and VisionPaid life insurance for employees with additional optionsShort-term, and long-term disability optionsPet care insuranceFlexible Spending Account – Health Care/ChildcareWellness programs that promote a healthy work-life balanceCareer advancement opportunities and professional developmentCompetitive salary with annual merit increaseTeam bonus opportunitiesEducation & ExperienceFour (4) years of experience with the development and remediation of moderately complex system configurations, including capitated provider agreement configurationsBachelor's degree from an accredited institution requiredIn lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this positiontwo (2) years of general healthcare experience plus two (2) years of configuration experience is requiredKey QualificationsKnowledge of Medicare and Medi-Cal fee schedules and benefit structure, and regulatory billing guidelines requiredKnowledge of CMS, DHCS, DMHC, NCQA rules and regulations preferredExtensive knowledge of CPT, HCPCS, Revenue, ICD10 coding rules and guidelines preferredExtensive knowledge of general managed care operations required; delegated plan model preferredBasic knowledge of relational database structureAdvanced knowledge of Product System algorithms and processes preferredFamiliar with basic medical product processing preferred