Remote Health Plan Configuration Analyst

Ventura County Medi-Cal Managed Care Commission; California; Hybrid; USD 100.000 - 150.000; Vollzeit

Zusammenfassung

Gold Coast Health Plan in California seeks an experienced HRP configuration professional to translate business requirements into accurate configuration across benefits, contracts, pricing, and claims edits. You will apply HealthRules Language and Designer/Manager to model complex logic and ensure regulatory alignment with Medi-Cal rules.

The role requires 2–5 years in HRP configuration within a CA health plan, strong analytical and documentation skills, and the ability to work independently in a

Qualifikationen

• 2-5 years configuration experience with HRP across benefits, provider contracts, pricing rules, and claims edits.
• California health plan experience; Medi-CAL preferred.
• Experience with healthcare EDI and code sets (HIPAA 837/835/834/270/271; ICD-10, HCPCS, CPT, DRG, APC, NDC).

Aufgaben

• Translate business requirements into HRP configuration across benefits and pricing.
• Build and maintain benefit structures, dictionaries, coverage tiers, copays, deductibles, and mappings.
• Configure provider reimbursement logic including fee schedules, capitation, FFS and value-based rules.
• Apply HRP tools to model complex logic with minimal custom code.
• Develop test scenarios and perform UAT for configuration changes.
• Support production validation, post-release monitoring and defect remediation.

Kenntnisse

Communication skills

Analytical thinking

Documentation skills

Ausbildung

Bachelor’s degree

Tools

HealthRules Language

Designer/Manager

Answers/Connector

Jobbeschreibung

Gold Coast Health Plan in California seeks an experienced HRP configuration professional to translate business requirements into accurate configuration across benefits, contracts, pricing, and claims edits. You will apply HealthRules Language and Designer/Manager to model complex logic and ensure regulatory alignment with Medi-Cal rules.

The role requires 2–5 years in HRP configuration within a CA health plan, strong analytical and documentation skills, and the ability to work independently in a