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Systems Analyst (Healthcare)

Systems Analyst (Healthcare)

This is a contract position, primarily remote but candidates located in Texas are strongly preferred.

· 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 efficiency of proposed configuration solutions.
· Maintains thorough and concise documentation for tracking of all contract, benefit, fee schedule 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 accuracy and efficiency of processes.
· Handles fluctuating volumes of work and prioritizes work to meet deadlines and user needs of the Health Plan.

Experience:
Knowledge of current managed care business practices and adjudication systems used by the Health Plan
Proficiency in QXNT and /or CES configuration.
A working knowledge of claims processing, configuration of contracts, benefits, fee schedules, and Claims Editing System; ability to interpret business requirements into system coding edits, and testing of configuration builds.

  • Contract
  • TX

I.T. Staffing

Description

This is a contract position, primarily remote but candidates located in Texas are strongly preferred.

· 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 efficiency of proposed configuration solutions.
· Maintains thorough and concise documentation for tracking of all contract, benefit, fee schedule 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 accuracy and efficiency of processes.
· Handles fluctuating volumes of work and prioritizes work to meet deadlines and user needs of the Health Plan.

Experience:
Knowledge of current managed care business practices and adjudication systems used by the Health Plan
Proficiency in QXNT and /or CES configuration.
A working knowledge of claims processing, configuration of contracts, benefits, fee schedules, and Claims Editing System; ability to interpret business requirements into system coding edits, and testing of configuration builds.

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