Configuration Analyst, Senior

Health Plan of San Joaquin/Mountain Valley Health Plan; French Camp (CA); A distancia; USD 110.000 - 150.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote work option

Comprehensive benefits

Descripción de la vacante

Health Plan of San Joaquin is seeking a Senior Configuration Analyst to manage system configurations for health plan implementations and conversions. You will interpret guidelines, convert them to configuration parameters, and mentor a team of analysts.

Responsibilities include leading Agile sessions, documenting technical requirements, and collaborating with executives to resolve complex issues. Prior experience in healthcare configuration is essential.

Formación

• This role requires extensive experience in healthcare configuration and data analytics.
• Experience interpreting benefits, contracts and business requirements.
• Proficient in SQL and business reporting.

Responsabilidades

• Manage system configurations for health plan implementations and conversions.
• Interpret state/federal guidelines and convert to configuration parameters.
• Mentor Configuration Analysts and document technical requirements.
• Lead Agile sessions for What and How, documenting stories and acceptance criteria.
• Collaborate with executives and business analysts to resolve complex problems.
• Develop testing plans for software systems used by the organization.

Conocimientos

QNXT configuration

SQL

Data analysis

Project management

Agile

Mentoring

Educación

Bachelor's degree in Computer Science or related field

Herramientas

Visio

Team Foundation Server

Attachmate

Microsoft Office

Descripción del empleo

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

This is a remote position. MUST reside in California, preferably in our service area.

At this time, the Health Plan does not sponsor visa. Candidates must have legal and valid work authorization, Green Card, or U.S. citizenship.

What You Will Be Doing

This position is responsible for managing major system configurations, health plan implementations and conversions within the System Configuration team. The primary responsibilities include the accurate interpretation of specific state and/or federal guidelines that impact benefits, contracts, codification, and business requirements and converting them into configuration parameters within the core systems. Other responsibilities are coding, updating and maintenance benefit plans, provider set-up (demographic and contracts affiliations), fee schedules and various system tables through the user interface. The Senior Configuration Analyst elicits complex business requirements through group meetings, interviews, observation, and/or existing systems, and business or policy documentation. This role independently mentors and contributes to the Configuration Analysts team with complex and comprehensive documentation of the technical requirements or systems modifications in a format that facilitates a business and technical communication and understanding amongst the business department or individuals. The Senior Configuration Analyst must have the ability to independently analyze or mine data, draw sound conclusions, and is able to interpret and follow detailed and precise written and oral instructions such as checklists, process diagrams, and policy. The Senior Configuration Analyst will lead communications and facilitation efforts to present the documented findings and results from an analytical engagement. The position will be required to work with and mentor people of various professional, vocational, and educational backgrounds.

Essential Functions

• Independently works with Executives, Management, Staff, or Business analysts to identify, document, and redesign complex business concepts or processing conflicts.


• Lead and mentor in technical areas and independently provide knowledge and documentation exchange to educate team members in Analytical roles in support of team redundancy.


• Master and provide formal user education with software productivity and technical tools such as Microsoft Office, Visio, Team Foundation Server, or Attachmate to document business and technical process requirements related to a technology system.


• Ability to independently create technical processing macros using programming logic and native functions to perform repetitive or analytical tasks within productivity software such as Microsoft Office and Attachmate.


• Comprehend, analyze, and document business or process requirements using personal interviews, document analysis, meetings, surveys, process documents, or actual scenarios.


• Take on duties of a Project Manager for medium to large sized projects using standard PMBOK processes to identify scope, requirements, resources, and stakeholders using standard analysis techniques.


• Analyze and document functional business environments that facilitate work throughout the company.


• Develop complex business requirement specifications through internal and external research to complete technical analysis, and articulate and formally present research to various skill levels.


• Lead business meetings leveraging the Agile process to assist business units in the “What” session to ensure the creation and documentation of stories and acceptance criteria.


• Lead Configuration and Project teams in the Agile “How” session to understand technical requirements related to the business stories and acceptance criteria.


• Effectively communicate and collaborate with internal and external customers in support of analytics or problem resolution.


• Successfully engage in multiple complex initiatives simultaneously


• Recommend reconciliation points necessary after a comprehensive process or data analytics engagement to mitigate/resolve present and future reconciliation conflicts.


• Possess excellent verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts.


• Limited skills in capacity of the various department technological resources and their roles in order to provide detailed analytics in everyday communications.


• Master of the American National Standards Institute (ANSI) formats that govern healthcare Electronic Data Interchange (EDI).


• Expert ability in the structure query language (SQL) for analytical data mining, software development, TFS, and business reporting.


• Comprehend and implement system configuration changes of the managed care core system software to process data transactions for business functions such as eligibility, claims, authorizations, and case management.


• Mentors and leads in the creations of testing plans that are used in the testing and implementation of software systems used by the organization.


• Comprehensive understanding in medical terminology to include ICD, CPT, and HCPCS coding systems.


• Oversee, identify, and create process checklists, for self and other analysts, which will be used to process HPSJ Health Systems (HPSJ) programs and applications to support departmental activities.

What You Bring

Knowledge, Skills, Abilities and Competencies

Required

• Extensive knowledge of all core QNXT system modules


• Ability to configure and update all standard core QNXT system modules


• Extensive knowledge of core QNXT system databases


• Ability to independently perform complex system and data analytics


• Extensive knowledge of other systems such as OPTUM PPS, CES, and NetworX Pricer and Modeler

• Extensive knowledge of other systems such as JIVA or other Medical Management Platforms


• Ability to independently create intermediate SQL queries


• Ability to independently leverage advanced SQL functions such as temp tables, multiple joins, inner/outer joins, and advanced analytics.


• Ability to independently create pivot tables from SQL output


• Ability to independently leverage all data sets and DBs


• Ability to independently create scripts to update data


• Extensive knowledge of core system databases and the ability to assist other technical staff with navigating system data, including the data structures for reporting.


• Ability to independently comprehend technical infrastructure including systems, DB, integration points, and reporting for coordination of efforts on systems managed by config team


• Ability to provide recommendations for process improvement, automation, and enhancements


• Ability to effectively communicate with technical and non-technical disciplines


• Ability to independently lead in cross functional business and technical meetings


• Ability to independently perform Scrum Master duties


• Ability to maintain effective working relationships with all teams


• Ability to independently perform Scrum Master duties


• Ability to lead small (3-6 months) department projects


• Extensive experience and knowledge of the Agile Methodology

What You Have

Education and Experience

Bachelor’s degree in Computer Science, Mathematics from an accredited institution or related field; and

Six (6) years progressive experience in a Configuration Analyst capacity or similar Analytical position for a medium to large organization with a structured IT department in healthcare.

OR

Experience

Healthcare experience: 10+ years.

Claims Operations or application vendor experience: 5 + years.

Benefit and Contract Configuration experience: 3+ years

Experience interpreting benefits, contracts and other business requirements: 5+ years

Experience in medical coding initiatives and coding guidelines: 3 + years

Experience in Medical Management system configuration. 3+ years

Experience in Medical Management system configuration. 3+ years

Expert level of knowledge in QNXT and/or JIVA

The incumbent must have basic technical skills that come from a Degree in Information Systems or 6-8 years of general analytical experience.

License

None required

HPSJ Perks

What You Will Get:

• Robust and affordable medical coverage including HMO and PPO plan options


• Employee Wellness Program promoting physical, mental, and financial well-being


• Dental and vision plan with multiple provider choices


• Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays, and 9 paid holidays)


• CalPERS retirement pension program, automatic employer-paid retirements contributions, plus a voluntary defined contribution plan


• Two flexible spending accounts (FSAs)for healthcare and dependent care expenses


• Employer-Paid Term Life and AD&D Insurance


• Employer-Paid Disability Insurance


• Employer-Paid Assistance Program (EAP)


• Health Advocacy to help you navigate medical care and benefits


• Voluntary supplemental benefits including medical, legal, identity theft protection


• Online discount mall


• Tuition reimbursement


• Remote work contingent on business needs and company guidelines


• A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do

Physical Demands

Work may require frequent sitting, standing, and walking, constant repetitive motion, frequent talking and listening, closeup and distance vision requirements. Some work may require occasional travel based on the responsibilities of the position and business needs and occasional handling materials up to 50 pounds.

Emotional/Psychological Demands

Ability to cope with a fast-paced work environment, working under pressure, dynamic priorities and deadlines, constant decision making, working irregular hours, emotional and sensitive situations.

Work Environment

Work may be performed in a remote, hybrid, or onsite setting depending on the requirements of the position and business needs. For roles performed remotely, employees are expected to maintain a secure, distraction-free workspace, and reliable internet connectivity consistent with company standards.

Important Notice : The duties, qualifications, and physical and emotional requirements listed in this job description are not exhaustive. Health Plan of San Joaquin reserves the right to revise this job description at any time.