Senior Configuration Analyst - Smithfield, United States - Neighborhood Health Plan of RI

Description

Job Details

Job Location

Smithfield, RI - Smithfield, RI

Position Type

Full Time

Travel Percentage

Occasional

Job Shift

Daytime

Job Category

Professional / Experienced

Description


Position Overview:
(On-site, Smithfield, RI)

The Senior Configuration Management Analyst is senior level position responsible for the analysis, design, build, testing, implementation, and maintenance of system configuration to support business requirements and optimize system functionality.

This position is responsible for identifying areas of automation and enhancement to support and improve internal workflows, review system capabilities, and identify gaps and limitations.

In addition, this role is responsible for ensuring adherence to the system development lifecycle and maintenance of all supporting documentation.

The role requires strong analytical and problem-solving skills, the ability to work independently and proactively as well as demonstrated skills in providing excellent customer service.

Extensive knowledge of all aspects of heath care operations workflow and terminology is also required.

Duties and Responsibilities

The duties for this position include, but are not limited to the following items:

Collaborate with business areas to understand financial impact to the organization for approved Medical Cost Action projects

Triage, research, and resolve escalated issues within industry standard timeframes to meet service level agreements

Responsible for identifying areas of unused/underutilized system functionality to support business initiatives

Perform post-implementation audits to ensure configuration aligns with current business requirements and process

As required, facilitate and lead meetings and selected workgroups

Mentor and train Configuration Analysts on configuration best practices

Assist management in in onboarding new hires, acting as onboarding buddy, and leading training sessions

Assist management with oversight of augmented staff by tracking performance, escalating issues, etcServe as a key resource in facilitating the gathering of business and technical requirements in addition to test cases for all configuration changes

Work with corporate project stakeholders and Business Analyst to formulate and communicate business requirements and scope of project

Work with various business areas at different levels within the organization to translate business requirements into technical specifications documents and also act as liaison to translate technical questions and processes into a format the business can understand

Analyze business requirements and objectives and perform system configuration analysis, design, coding, and unit testing following established processes, standards and procedures

Develop and maintain a library of standard operational procedures for all configuration tasks, including but not limited to creating and configuring benefit plans using best practice

Execute the build and implementation of benefit plan adjudication rules

Perform all configuration changes within multiple test environments, coordinating with testing and project teams to establish timelines and project planning in an effort to maintain the integrity of the environment in use

Responsible for configuration in depth research, review, and creation of claims data to validate configuration output is performing as expected

Handle the change control process when configuration results do not match expected outcome, partners with Business Analyst and Testing team to find solutions as needed

Develop and execute multiple unit test cases and complete Configuration Control Framework documentation to support configuration audit requests

Act as a liaison between business stakeholders and technical teams to validate and translate unit, positive, negative and regression testing results and any remediation necessary

Coordinate and document all configuration activity for change control and auditing

Responsible for coordination of production turnover of all configuration work upon business owner sign off as well as post-production validation

Responsible for the Configuration Management Promotion process for HealthRules, Optum CES, and Burgess Source and other systems as needed

Serve as subject matter expert for root cause analysis and issue resolution, by providing guidance on system limitations and functionality

Develop proof of concepts prototype configuration to support business requirements and develop documented solutions and processes

Identify gaps between business expectations and system limitations and suggest configuration improvements or streamlined maintenance processes and techniques

Responsible for completing Peer Quality review of configuration updates

Coordinate with the Neighborhood Application Support ticket tracking and bringing to resolution any software, configuration, EDI, CES tickets that require updates to the test or production environments

Perform business analysis duties for designated corporate projects and maintenance requests

Oversee process development and documentation for any new or altered functionality or business process. This will also include facilitating an annual audit of actual business processes versus what is documented

Identify potential areas of automation and aid in re-engineering the underlying business processes

Recommend and maintain standards for development of business cases and their documentation

Coordinate multiple simultaneous projects and initiatives, while maintaining business as usual tasks.

Other duties as assigned

Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company.

This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents


Core Company-Wide Competencies:
Communicate Effectively

Respect Others & Value Diversity

Analyze Issues & Solve Problems

Drive for Customer Success

Manage Performance, Productivity & Results

Develop Flexibility & Achieve Change


Job Specific Competencies:
Collaborate & Foster Teamwork

Attend to Detail & Improve Quality

Create & Innovate

Plan & Organize


FDR Oversight:
N/A


Travel Expectations:
N/A (e.g., Some travel locally between locations is required.)

Neighborhood Health Plan of Rhode Island is an equal opportunity employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Qualifications


Qualifications Required:
Bachelor's degree or a minimum of Five (5) years of experience and background equating to the degree in a health care setting

Minimum of Five (5) years of business analysis and system configuration experience (or comparable skill set) working in a health care setting

Demonstrated working knowledge of health care operations including but not limited to authorizations, benefits, enrollment, provider contracting, fiscal operations and claims adjudication

Demonstrated working knowledge of system development life cycle processes

Experience in identifying solutions to resolve design issues and to effectively communicate these solutions to the project manager/supervisor as well as stakeholders

Experience in translating the results of design sessions into configuration requirements

Experience in user acceptance testing based on business and configuration requirements

Exceptional ability to identify and track issues and drive them to a conclusion

Demonstrated ability in leading process improvement initiatives

Experience producing project artifacts to include status reports, business requirements, non-technical design documents, etc.

Excellent interpersonal skills, including the ability to work across the organization and to interact, influence and negotiate effectively at all levels of management

Demonstrated ability to manage multiple priorities simultaneously in a deadline driven environment with accurate resource and time estimates

Confident team builder and leader with strong motivational skills. Adept in problem solving and resolving conflict

Proficient in Microsoft Office Suite - Word, Excel, PowerPoint, Visio, Outlook, SharePoint


Qualifications Preferred:
Bachelor's Degree in Health Care or Technology

Experience with Optum CES claim editing software

Experience with the Health Rules Payor Transactional System

Working knowledge of State and Federal insurance programs

Working knowledge of standard billing practices

Working knowledge of CMS mandates and guidelines

Certified Professional Coder

Neighborhood Health Plan of Rhode Island is an equal opportunity employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

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