Configuration Analyst

We’re searching for a Configuration Analyst who thrives in a fast-paced setting. This role focuses on system updates, new health plan implementations, and conversions within Business Operations. You’ll design configuration solutions to meet new business requirements and perform updates for benefits, coding, contracts, fee schedules, or claim editing rules while adhering to business policies and state requirements.

Responsibilities

• Performs daily configuration changes in claim adjudication systems.
• Analyzes incoming requests and designs configuration solutions to meet business requirements.
• Performs configuration changes for coding, contracts, benefits, fee schedules, and claim editing rules as needed.
• Creates testing scenarios to demonstrate efficiency of proposed configuration solutions.
• Maintains thorough and concise documentation for tracking all contracts, benefit, fee schedule, and claim editing rule changes related to Change Control Management or issues for quality audit purposes.
• Executes configuration changes accurately and timely to meet department standards for quality and service level agreements.
• Assists with the development of configuration standards and best practices.
• Identifies claims impacted by configuration changes and sends reports to the claims administration department for reprocessing.
• Monitors pended claims and work queues to update appropriate systems.
• Escalates identified issues, makes recommendations, and assists with implementing configuration changes to improve accuracy and efficiency of processes.
• Handles fluctuating volumes of work and prioritizes tasks to meet deadlines and user needs of the Health Plan.
• Performs system configuration design analysis associated with projects.
• Analyzes configuration errors and identifies required modifications.
• Supports new system implementations and upgrades.

Requirements

• High School Diploma or GED (bachelor’s degree preferred).
• 2 years of experience in managed care, claims processing, and/or configuration of benefits, contracts, fee schedules, or medical policy payment rules.
• A bachelor’s degree may substitute for the required work experience.

Skills

• Preferred: Epic Tapestry configuration experience.

About Us

Founded in 1996, Texas Children’s Health Plan is the nation’s first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children’s Health Insurance Program (CHIP) to pregnant women, teens, children, and adults in Houston and surrounding areas. Currently, the Health Plan serves more than 375,000 members through a network of over 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children’s Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.