Health Plan Configuration Specialist

Texas Children's Hospital; Town of Texas (WI); On-site; USD 65,000 - 90,000; Full time

Job summary

Texas Children's Hospital is seeking a Configuration Analyst to manage daily configuration changes in claim adjudication systems and design solutions for business requirements. You will support coding, contracts, benefits, fee schedules, and rule edits while maintaining change-control documentation and meeting quality standards.

The role involves testing scenarios, standards development, and coordinating with claims administration to reprocess impacted claims.

Qualifications

• Required H.S. Diploma or GED with a preferred bachelor's degree.
• Required 2 years Managed care, claims processing, and/or configuration of benefits/contracts/fee schedules/medical policy payment rules.
• A bachelor's degree may substitute for the required work experience.
• Preferred Epic Tapestry configuration experience.

Responsibilities

• Performs daily configuration changes in claim adjudication systems.
• Analyzes incoming requests and designs configuration solutions to meet business requirements.
• Performs configuration changes for coding, contracts, benefits, fee schedules and claim editing rules as needed.
• Creates testing scenarios to demonstrate efficiency of proposed configuration solutions.
• Maintains thorough and concise documentation for tracking of all contracts, benefit, fee schedule and claim editing rule changes related to Change Control Management or issues for quality audit purposes.
• Executes configuration changes in an accurate and timely manner to meet the department’s standards for quality and service level agreements.
• Assists with the development of configuration standards and best practices.
• Identifies claims impacted by configuration changes done in the system and sends reports to the claims administration department for reprocessing.
• Monitors pended claims and work queues to update appropriate systems. Responsible for escalating identified issues, making recommendations, and assisting with implementing configuration changes to improve accuracy and efficiency of processes.
• Handles fluctuating volumes of work and prioritizes work to meet deadlines and user needs of the Health Plan.
• Performs system configuration design analysis associated with projects.
• Analyzes configuration errors and identifies required modifications.
• Supports new system implementations and upgrades.

Skills

Configuration management

Claims processing

Healthcare experience

Education

High school diploma or GED

Bachelor's degree preferred

Tools

Epic Tapestry

Job description

Texas Children's Hospital is seeking a Configuration Analyst to manage daily configuration changes in claim adjudication systems and design solutions for business requirements. You will support coding, contracts, benefits, fee schedules, and rule edits while maintaining change-control documentation and meeting quality standards.

The role involves testing scenarios, standards development, and coordinating with claims administration to reprocess impacted claims.