Remote Configuration & Data Analyst II (PA/PD)

SCAN Health Plan; Long Beach, Northern (CA, KY); Hybrid; USD 72,000 - 104,000; Full time

Benefits offered by this job

Annual bonus program

Wellness Program

PTO

11 holidays + floating + birthday

401(k) with employer match

Tuition reimbursement

Remote work

Job summary

SCAN Health Plan is seeking a Configuration Analyst II to support the configuration, testing, and governance of PA and PD code sets across claims and related systems. You will partner with Medical Policy, Utilization Management, IT, and vendors to ensure accuracy and timely deployment.

The ideal candidate has 2+ years in healthcare analytics, strong SQL skills, and experience with QNXT. Remote work options and a comprehensive benefits package accompany this role.

Qualifications

• Bachelor's Degree or equivalent experience in Healthcare Administration, Health Information Management, Information Systems, Data Analytics, Business, Computer Science, or related field.
• 2 or more years of experience in healthcare systems, operations, analytics, medical coding, utilization management, or related technical functions.
• 2 or more years of experience with reporting, data analysis, SQL, or healthcare-related data.
• Experience working with healthcare coding systems, code set maintenance, or authorization-related processes.
• Knowledge of healthcare coding systems, including CPT, HCPCS, and related code sets.
• Understanding of healthcare claims processing, utilization management, authorization workflows, and healthcare operations.
• Knowledge of CMS regulations and Medicare Advantage and Medicaid program requirements preferred.
• Strong analytical and problem-solving skills, including data interpretation, issue identification, root cause analysis, and solution development.
• Proficiency in data analysis, reporting, performance measurement methodologies, SQL, reporting tools, and business intelligence platforms preferred.
• QNXT experience is required.
• Proficiency with Microsoft Office Suite and related business productivity applications.
• Excellent written and verbal communication skills with the ability to explain technical concepts to technical and non-technical audiences.
• Strong organizational skills, attention to detail, and ability to manage multiple priorities and deadlines.
• Demonstrated ability to work independently while collaborating across multidisciplinary teams.
• Commitment to accuracy, quality, compliance, continuous improvement, and standard office-based work activities, including computer and office equipment use for extended periods.

Responsibilities

• Maintains PA and PD code sets across claims, utilization management, and related operational systems.
• Supports benefit configuration and prior authorization activities, including configuration, testing, validation, deployment, and post implementation review.
• Serves as a technical liaison for PA and PD configuration activities with internal teams, delegated entities, providers, and vendors.
• Troubleshoots and resolves benefits and authorization-related configuration issues, technical inquiries, and system problems impacting operational workflows.
• Supports Annual Enrollment Period (AEP) readiness by completing assigned benefit configuration activities, validating configuration accuracy, and meeting established implementation timelines.
• Analyzes data to identify trends, risks, process improvement opportunities, and operational or financial impacts.
• Supports continuous improvement initiatives by enhancing workflows, reporting capabilities, data quality, system functionality, and operational efficiency.
• Creates and maintains procedures, workflow documentation, training materials, and other resources supporting PA and PD list operations.
• Maintains knowledge of healthcare coding standards, authorization processes, CMS regulations, healthcare technology, and related best practices.
• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Skills

SQL

Power BI

Healthcare analytics

Data analysis

Education

Bachelor's degree or equivalent

Tools

MHK

ikaSystems

CareAxis

Job description

SCAN Health Plan is seeking a Configuration Analyst II to support the configuration, testing, and governance of PA and PD code sets across claims and related systems. You will partner with Medical Policy, Utilization Management, IT, and vendors to ensure accuracy and timely deployment.

The ideal candidate has 2+ years in healthcare analytics, strong SQL skills, and experience with QNXT. Remote work options and a comprehensive benefits package accompany this role.