Configuration Quality Assurance Analyst I

Responsibilities

• Collaborate with Lead Auditor and training team to identify audit trends and staff training needs
• Perform monthly retrospective audits of Configuration Analyst I and Configuration Specialist staff
• Perform concurrent audits of Configuration Analyst I and Configuration Specialist staff
• Provide feedback to Configuration management team on staff performance relating to accuracy of work or system enhancements
• Document audits and report all audit outcomes for Configuration management review
• Writes and/or provides input on Configuration department procedures
• Maintain current knowledge of assigned configuration areas of responsibility, and related PHC Policy and Procedure, Medi-Cal Provider Manual, Title 22 regulations, CMS Medicare regulations, and Knox Keene regulations
• Maintain current knowledge of all PHC processes that impact Configuration department responsibilities including but not limited to: Claims, Member Services, Finance, Pharmacy, Health Services, Provider Relations, IT-EDI, IT- Amisys, IT- Webteam processes
• Support design and enhancement to Configuration audit process
• Support configuration related testing activities
• Support configuration related project activities

Qualifications

• Bachelor’s degree in related field preferred
• Experience with AMISYS Advance or other claims payment system, fee schedules, and procedure/diagnosis code tables preferred
• Prior training and/or auditing experience desirable
• Minimum three (3) years of healthcare experience preferably in a managed care environment; or equivalent combination of education and experience