Analyst II - Product System Configuration

Overview 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. 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. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary Telecommute schedule State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account – Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities 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. Analyze and translate business specifications into detailed technical specifications based on system functionality and develop non-systematic workaround processes when necessary. Perform product system error root cause analysis. Track incoming requests and issue resolution through Microsoft Access, MediTrac, and Workfront tools. Identify and communicate impact of system enhancements or configuration changes on integrated systems and processes. Monitor and work daily System Configuration inventory and ensure compliance with established service level agreements and regulatory timelines. 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. Assist Contracting team with drafting appropriate contract fee schedule language to be in line with system adjudication capabilities and coding standards. Develop and maintain business requirements for the automation of coding updates. Track, test, and approve new system functionality, enhancements, and bug fixes, including the development and execution of test plans and scripts. Perform weekly/bi-weekly audit of check run products to proactively identify potential system configuration issues before products are released. Other duties as assigned, including but not limited to Department Projects and LEAN/A3 Events. Qualifications Education & Requirements  Four (4) years of experience with the development and remediation of moderately complex system configurations, including capitated provider agreement configurations Experience in major managed care system migration/implementation preferred 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 This experience is in addition to the minimum years listed in the Experience Requirements above 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 Skilled in the use of Microsoft Excel and Access preferred Exceptional problem solving and critical thinking skills Strong presentation and written communication skills Ability to work independently and solve complex problems with little to no assistance Ability to effectively manage multiple competing priorities Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs a