Configuration Analyst II

 
Location: Newark, New Jersey
Posted On: 10/4/2017
Job Code: 7559_Configuration A
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Job Description
 
• Identifies pricing and configuration issues and recommends solutions to solve gaps between external expectations and system limitations, suggesting configuration improvements or streamlined maintenance processes. Initiates error correction and claim re-adjudication related to fee schedule, contract configuration, and other file discrepancies.
• Develops test plans and completes file, data, and logic validation while performing user acceptance testing for updates instituted by Vendor. Performs post-implementation validation of all related changes moved into the production environment.
• Develops business specifications for RFAs, ASO inquiries, and other requests, recognizing any gaps and deficiencies and making recommendations to enhance current processes.
• Serves as department subject matter expert (SME) while attending sessions on benefits reimbursement, policy development, configuration, and other committees/meetings with business owners and assist with the development of complete business requirements for configuration projects.
• Assists with the development of Business Configuration Analysts job aids, training materials, reference guides, and other documentation. Train other Analysts/Consultants/Temps as needed for assistance on assigned projects.
• Analyzes complex provider contracts and design/configure provider agreements, including validation of configuration and peer review.
• Assists manager in prioritizing unit activities identifying those items which are critical to client’s business operations as highest priority.
• Researches and resolves audit related inquiries, determines root cause of payment discrepancies, and reports all findings to Manager.
• Updates and maintains key inventory logs for management review to assist with inventory controls and quality audits.
• Assists vendor with the configuration of edits, CPT/HCPCS & ICD10 procedure and diagnosis codes, place and service code mapping annually or as required for accurate claims processing.
Category:IT  code:new
 
 
Job Requirements
 
 
Configuration, Health care, production environment and Test
 

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Contact Details
 
Recruiter
Pradeep Mahawar
 
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LinkedIn
linkedin.com/in/pradeep-mahawar-589108105