[Hiring] HealthRules Payor Configuration Analyst @DMS Vision

Role Description

The HRP Configurations Analyst ensures the integrity of the health plan claims processing by reviewing, analyzing, and configuring the health plans' core system platforms. You will obtain and analyze the internal workflow, setup, and design of the software applications to ensure that the core claims system is configured correctly with legal plan documents and regulatory requirements.

• Consult with users to identify current operating procedures and to clarify program objectives
• Create documentation to describe program development, benefit logic, medical coding, work instructions, and corrections
• Interpret manuals prepared for users to describe operating procedures
• Perform a variety of complicated tasks to ensure that the core claims system is configured correctly by reviewing the system components, and validating the configuration aligns with plan documents and regulatory requirements
• Develop a deep understanding of the system capabilities and evaluate requirements to determine configuration design
• Provide analysis and documentation that supports configuration management, design, requirements traceability, and audit controls needed to meet state and federal regulatory requirements
• Develop and improve workflows and business processes to improve customer service, decrease operational costs, and improve overall quality

Qualifications

• 5+ years' of experience in HealthRules Payor healthcare claims system design and configuration
• Experience building out benefits plans in HealthRules Payor
• Must possess claims processing knowledge, and knowledge of benefit/claims configuration for claims and enrollment systems
• Ability to contribute to process improvement projects
• Excellent analytical, organizational, and problem-solving skills
• Must possess knowledge of audit processes and system controls

Company Description