Core Systems Configuration Analyst II at Kforce Inc.
Los Angeles, CA 90017
About the Job
- Maintain benefit dictionaries, evidence of coverage tables, provider contractual obligations (including capitation and fee-for-service contracts), Division of Financial Responsibility (DoFR), etc. and related documentation
- Identify, analyze, and review well thought-out recommendations for end-to-end configuration improvements
- Conduct root cause analysis to identify issues and provide well thought-out recommendations for resolution
- Interface and collaborate with peers within and outside of the department and the organization to support configuration management best practices, systems enhancement processes, management of the system configuration life cycle management project/program plans, tracking of configuration change operational issues and resolution
Requirements:
- Bachelor's degree in Business Administration or Health Administration
- Master's degree in Business Administration or Health Administration
- 5+ years of experience in a Systems Configuration, Claims or other Operations department
- 5+ years experience working with a California Medi-Cal managed care plan or commercial health plan, medical group, or management services organization (preferred)
- Advanced claims experience with QNXT or equivalent claims processing system
- Systems configuration experience in the health care industry
- Advanced knowledge of and experience with interpreting and analyzing complex pricing mechanism and contractual terms with providers, delegated groups and related contractual scenarios
- Advanced understanding of the application of the Division of Financial Responsibility (DoFR) to claims processing
- Advanced knowledge of and experience with Medicare and Medicaid rules and regulations and related core systems code and data sets, etc.
- Strong communication, analytical, organizational, and time-management skills
- Able to meet strict, tight deadlines with a high level of accuracy
The pay range is the lowest to highest compensation we reasonably in good faith believe we would pay at posting for this role. We may ultimately pay more or less than this range. Employee pay is based on factors like relevant education, qualifications, certifications, experience, skills, seniority, location, performance, union contract and business needs. This range may be modified in the future.
We offer comprehensive benefits including medical/dental/vision insurance, HSA, FSA, 401(k), and life, disability & ADD insurance to eligible employees. Salaried personnel receive paid time off. Hourly employees are not eligible for paid time off unless required by law. Hourly employees on a Service Contract Act project are eligible for paid sick leave.
Note: Pay is not considered compensation until it is earned, vested and determinable. The amount and availability of any compensation remains in Kforce's sole discretion unless and until paid and may be modified in its discretion consistent with the law.
This job is not eligible for bonuses, incentives or commissions.
Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.
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