Configuration Analyst

1. Comprehend, analyze, and configure the claims core system including plan and carriers, program edits, benefits, procedure codes, service groups, fee schedules, provider contracts, affiliations, and all other configurations.
2. Comprehend, analyze, and configure the medical management core system including episode, sentinel rules, integration, data synchronization, letters, and all other configurations.
3. Ability to interpret simple and complex provider contracts and amendments, define requirements to configure, test, and promote within environments, and audit.
4. Responsible for testing and remediation of all core system updates and changes.
5. Researches and develops recommendations for enhancements and/or improvements by leading the analysis of existing processes, procedures, requirements, and utilization of existing systems.
6. Provides guidance in problem identification and the implementation of solutions that address gaps and configuration needs.
7. Independently works, or under the direction of Project Manager or Senior Analyst, with Executives, Management, Staff, or Business analysts to identify, document, and redesign complex business concepts or processing conflicts.
8. Lead and mentor in areas that need cross-training and independently provide knowledge and documentation exchange to educate team members in Analytical roles in support of team redundancy.
9. Provide formal user education with software productivity and technical tools such as Microsoft Office, Visio, Team Foundation Server, or Attachmate to document business and technical process requirements related to a technology system.
10. Comprehend, analyze, and document business or process requirements using personal interviews, document analysis, meetings, surveys, process documents, or actual scenarios.
11. Take on duties of a Project Manager for small projects using standard PMBOK processes to identify requirements, resources, and stakeholders using standard analysis techniques.
12. Analyze and document functional business environments that facilitate work throughout the company.
13. Develop complex business requirements and specifications through internal and external research to complete technical analysis, and articulate research back to various skill levels.
14. Facilitate business meetings leveraging the Agile process to assist business units in the "What" session to ensure the creation and documentation of stories and acceptance criteria.
15. Work with Configuration and Project teams in the Agile "How" session to understand technical requirements related to the business stories and acceptance criteria.
16. Effectively communicate and collaborate with internal and external customers in support of analytics or problem resolution.
17. Successfully engage in multiple complex initiatives simultaneously
18. Analyze and evaluate information gathered from multiple sources to resolve reconciliation conflicts.
19. Possess excellent verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts.
20. Comprehensive understanding of the various department technological resources and their roles in order to utilize various forms of electronic resources in everyday communications.
21. Understanding and experience with the American National Standards Institute (ANSI) formats that govern healthcare Electronic Data Interchange (EDI).
22. Proficient with the structure query language (SQL) for analytical data mining, software development, TFS, and business reporting.
23. Comprehend and implement system configuration changes of the managed care core system software to process data transactions for business functions such as eligibility, claims, authorizations, and case management.
24. Designs, develops and/or assist in the testing and implementation of software systems used by the organization.
25. Understanding of medical terminology to include ICD, CPT, and HCPCS coding systems.
26. Identify and create personal process checklists that will be used to process Client programs and applications to support departmental activities.
27. Tactfully identify issues, makes recommendations, and implements configuration changes to improve automation and accuracy.
28. Ability to handle fluctuating volumes of work and be able to prioritize work to meet deadlines and needs of stakeholders.
29. Creates management reporting tools to enhance communication on configurations updates and initiatives.
30. Responsible for maintenance of existing systems including impact analysis, coordination with IT disciplines, and testing with IT and business units.