Senior Provider Configuration Analyst (Health Edge, Burgess, Provider Pricing, Fee Schedule, Co[...]

MetroPlusHealth; New York (NY); On-site; USD 85,000 - 110,000; Full time

Job summary

A healthcare organization is seeking a Senior Provider Configuration Analyst to ensure the proper configuration of their systems for claims processing. This role requires 6+ years of experience in data processing within a healthcare or claims environment and focuses on provider reimbursement configurations, workflow analysis, and system performance management. Ideal candidates will have a Bachelor's degree and experience with HealthEdge HRP and Source products. Additional competencies include attention to detail and the ability to manage multiple priorities.

Qualifications

• 6+ years of experience in configuration for data processing and computer systems.
• Experience in a healthcare or claims environment is essential.
• Demonstrated ability to analyze workflows and support system configuration.

Responsibilities

• Configure provider reimbursement and maintain fee schedules.
• Analyze departmental requirements for developing strategic plans.
• Ensure claims are processed accurately according to Provider contracts.

Skills

System configuration

SQL

Workflow analysis

Technical documentation

Customer focus

Education

Baccalaureate Degree (Computer Science preferred)

Tools

HealthEdge HRP

HealthEdge Source products

Job description

The Senior Provider Configuration Analyst will be responsible for the configuration of MetroPlusHealth’s systems to ensure that claims are processed according to Provider contracts.

Scope Of Role & Responsibilities

• Configure provider reimbursement and create and maintain fee schedules.
• Analyze departmental requirements needed to develop long and short-term plans.
• Ensure system processes and services are aligned with the needs of the department.
• Analyze the system to ensure claims are processed correctly to protect the company from liabilities.
• Collaborate with MetroPlusHealth’s system consultants to correct errors, rectify omissions, and investigate system issues.
• Identify potential system problems for claims resolution.
• Review test cases to ensure they are in accordance with requirements and assist with overall testing processes.
• Conduct ongoing reviews of systems and processes to ensure accurate and optimum setup for both provider and claims.
• Receive, coordinate, and manage requests for Systems Modifications.
• Maintain and track open issues and coordinate release testing.
• Assist with the system migration to HealthEdge HRP and Source products.
• Run reports and perform analysis using SQL.
• Create and maintain an inventory of pricing templates and their contents
• Monitor and Manage Core Systems performance
• Respond to escalated issues from various MetroPlusHealth Departments.
• Perform and assist with any other functions as required by the Director of Provider Contract Configuration
• Participate in special projects and strategic initiatives as needed.

Required Education, Training & Professional Experience

• A Baccalaureate Degree from an accredited college or university required, Computer Science preferred; and
• Six (6) years of progressive, responsible experience in configuration for data processing, computer systems and applications;
• Experience with HealthEdge HRP and Source products required.
• Demonstrated experience supporting system configuration, workflow analysis, and technical documentation in a healthcare or claims environment.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication
• Ability to work independently, manage multiple priorities, and maintain attention to detail.