Sr. Systems Configuration Analyst - Alignment Healthcare

Overview of the Role:

The Sr. Systems Configuration Analyst will play a crucial role in managing and optimizing the configuration of claims systems and applications. The Sr. Systems Configuration Analyst’s primary responsibility is to ensure claims systems and applications are accurately configured. This role will serve as one of the primary supports in analyzing, implementing and maintaining configuration settings to ensure compliance with company policies, contracts and industry standards. Serves as a subject matter expert for configuration and related best practices.

Responsibilities:

• Serves as a subject matter expert for configuration change management testing and related best practices
• Analyze and interpret documents related to claim system configuration, including provider contracts, division of financial responsibility (DOFR), and health plan benefits, to ensure accurate system configuration.
• Conduct regular audits and validation of system configuration to ensure accuracy, compliance with regulations, company policies and contracts. Identify and address discrepancies or issues promptly.
• Trouble shoot and resolves configuration-related issues, working closely with internal teams and external vendors as needed.
• Collaborates with cross-functional teams to identify configuration needs and implement effective solutions.
• Collaborates with internal and external auditors to support the audit process related to configuration, including the preparation, organization, and submission of necessary documentation.
• Maintains thorough and concise documentation for tracking of all configuration changes and system testing.
• Recommend process improvements to enhance the efficiency and effectiveness of system configuration.
• Assists in the development and training of process documentations and workflows.

Requirements:

• Minimum of 5 years of experience in claims system configuration with strong understanding of healthcare data system
• Bachelor’s degree in Health Informatics or related field
• Demonstrated experience in managing complex system configurations, performing system audits and resolving configuration-related issues
• Strong analytical and problem-solving skills, with the ability to interpret complex healthcare documents and translating them to system requirements
• Excellent communication and interpersonal skills, with the ability to collaborate effectively with cross-functional teams
• Detail-oriented with exceptional organization skills and the ability to manage multiple tasks and projects simultaneously
• Working knowledge of healthcare coding systems such as ICD, CPT, HCPCS, revenue codes and other related codes.
• Familiarity with data analysis tools and SQL, a plus

Preferred Qualifications:

• Experience with medical claims systems such as Facets, pricing tools such as Optum PPS, and clinical claims editing softwares.
• In-depth knowledge of healthcare regulatory requirements including medical coding and Medicare pricers

Pay Range: $75,000 - $95,000 annually.