[Hiring] Senior Configuration Analyst @Health Plan of San Joaquin/Mountain Valley Health Plan

Role Description

This position is responsible for managing major system configurations, health plan implementations, and conversions within the System Configuration team. The primary responsibilities include:

• Accurate interpretation of specific state and/or federal guidelines that impact benefits, contracts, codification, and business requirements.
• Converting guidelines into configuration parameters within core systems.
• Coding, updating, and maintaining benefit plans, provider set-up, fee schedules, and various system tables.
• Eliciting complex business requirements through group meetings, interviews, observation, and documentation.
• Mentoring and contributing to the Configuration Analysts team.
• Analyzing or mining data and interpreting detailed instructions.
• Leading communications and facilitation efforts to present documented findings.

Qualifications

• Extensive knowledge of all core QNXT system modules.
• Ability to configure and update all standard core QNXT system modules.
• Extensive knowledge of core QNXT system databases.
• Ability to independently perform complex system and data analytics.
• Extensive knowledge of other systems such as OPTUM PPS, CES, and NetworX Pricer and Modeler.
• Extensive knowledge of other systems such as JIVA or other Medical Management Platforms.
• Ability to independently create intermediate SQL queries.
• Ability to independently leverage advanced SQL functions.
• Ability to independently create pivot tables from SQL output.
• Ability to independently create scripts to update data.
• Ability to provide recommendations for process improvement, automation, and enhancements.
• Ability to effectively communicate with technical and non-technical disciplines.
• Ability to independently lead in cross-functional business and technical meetings.
• Extensive experience and knowledge of the Agile Methodology.

Requirements

• Bachelor’s degree in Computer Science, Mathematics, or related field.
• Six (6) years of progressive experience in a Configuration Analyst capacity or similar Analytical position.
• Healthcare experience: 10+ years.
• Claims Operations or application vendor experience: 5+ years.
• Benefit and Contract Configuration experience: 3+ years.
• Experience interpreting benefits, contracts, and other business requirements: 5+ years.
• Experience in medical coding initiatives and coding guidelines: 3+ years.
• Experience in Medical Management system configuration: 3+ years.
• Expert level of knowledge in QNXT and/or JIVA.

Benefits

• Robust and affordable medical coverage including HMO and PPO plan options.
• Employee Wellness Program promoting physical, mental, and financial well-being.
• Dental and vision plan with multiple provider choices.
• Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays, and 9 paid holidays).
• CalPERS retirement pension program with automatic employer-paid contributions.
• Two flexible spending accounts (FSAs) for healthcare and dependent care expenses.
• Employer-Paid Term Life and AD&D Insurance.
• Employer-Paid Disability Insurance.
• Employer-Paid Assistance Program (EAP).
• Health Advocacy to help navigate medical care and benefits.
• Voluntary supplemental benefits including medical, legal, and identity theft protection.
• Online discount mall.
• Tuition reimbursement.
• Remote work contingent on business needs and company guidelines.
• A chance to work for an organization that is mission-driven.