Business Configuration Analyst

About the Role

This position involves configuring and maintaining business rules within the claims adjudication ecosystem, providing technical support for the HealthRules software, and ensuring accurate claims payment and system functionality.

Responsibilities

• Configures and maintains business rules within the claims adjudication ecosystem.
• Configures HealthRules software from development into testing and production phases.
• Provides application and technical support for HealthRules software and troubleshoots for end users.
• Identifies, researches, and resolves inaccuracies and inconsistencies in business rules impacting claims payment and related transactions.
• Engages with business clients to evaluate requirements and recommends benefit setups based on system capabilities.
• Independently evaluates business procedures and problems, participating in requirements gathering sessions.
• Creates test case scenarios for application and configuration testing, ensuring readiness for production.
• Identifies and assesses potential problems, implementing system enhancements, modifications, and upgrades.
• Defines data reporting and trending reports with business clients, making recommendations to management.
• Designs and develops user system documentation.
• Works with IT to define business systems requirements and documents system design findings.
• Evaluates and monitors coded data elements.
• Assists users in understanding business system functions.
• Performs additional duties as assigned.

Requirements

• Thorough understanding of business rule configuration supporting reimbursement policies, member/provider contracts, and claims adjudication.
• Strong analytical, technical, and problem-solving skills.
• Experience working with multiple business systems and understanding of system design.
• Proficiency in Microsoft Office products and project management tools.
• Strong communication skills to convey complex technical concepts.
• Understanding of the business environment and corporate objectives.
• Detail-oriented with the ability to follow through on project life cycles.
• Experience in data analysis, testing, and implementation.
• Technical writing skills and ability to present findings to management.
• Ability to create timelines and collaborate with internal and external departments.
• Skills in coaching and mentoring.
• Ability to work independently on projects with minimal supervision.
• Strong presentation skills and knowledge of project management tools and methodologies.
• Proficiency in healthcare and health plan terminology, including medical coding (e.g., CPT, HCPCS, ICD9, CDT, Revenue, DRG).

Qualifications

• Bachelor’s degree in Business Administration, Management Information Systems, Computer Science, or equivalent work experience.
• In lieu of degree, 3-4 years of proven configuration experience, preferably on Facets, HealthRules, Diamond, Amisys Advance, or similar payer systems.
• 2+ years of healthcare operations or claims processing experience.
• Strong project management skills.

Schedule

Hybrid model: 3 days in-office (Tuesday, Wednesday, Thursday) and 2 days remote (Monday, Friday). Remote work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.

Additional Requirements

Must have an Android or iOS device compatible with the Microsoft Authenticator app.