Business Configuration Analyst Senior
Christus Health

Irving, Texas

Posted in Medical and Nursing


Job Info


Summary:

The Configuration Analyst Senior will work in conjunction with Auditing, Member Services, Complaints and Grievances, Provider Data, Utilization Management, Claims and other operational departments. The position will be responsible for gathering comprehensive business requirements and translating them into configuration design and implementation. A thorough understanding of healthcare systems, data collection, analysis, strong organizational and record keeping skills are required.

  • Oversight and coordination of core-system benefit configuration, including: Claim Check, Benefits, Group Structure, Check and Interest Packages, Service Categories, Benefit Categories, Optum Pricer (EasyGroup), Code Maintenance, License Maintenance, Auto-Adjudication, Provider Picking logic, Perfect Claim setting selection, Transforms, Claim Adjustment Reason and Remittance Advice Remark Codes, UniFlow Workflows, Reference Codes, and Custom Attributes
  • Benefit research, design, configuration, testing, and implementation for multiple product lines including Medicare, Commercial, Exchange, and Tricare
  • Research and resolution of defects related to UB04 and HCFA claims
  • Review, validate and load all codes for claims adjudication (ICD10, CPT9, HCPCS, Modifiers, HIPPS, DRG, etc.)
  • Configure coding exceptions and maintain the accuracy of clinical editing software (ex. Claim Check)
  • Demonstrate the ability to locate, research, comprehend, and appropriately apply 3rd party payer rules and regulations; analyze and resolve complex coding related claim denials in a manner that ensure accurate and optimal reimbursement
  • Coordinates with other departments to gather configuration requirements and provide feedback on change feasibility
  • Gathers and analyzes business requirements to determine the best approach for configuration design and implementation
  • Perform root cause analysis on benefit configuration set-up issues across all lines of business, documents results and present business impact analysis to management
  • Demonstrate strong decision making and problem-solving skills; the personal initiative to keep abreast of new developments in coding updates, technology, research, regulatory data; detail oriented and ability to meet deadlines
  • Review appropriate regulatory references to identify/substantiate diagnoses, procedures and modifiers that support services billed
  • Implement and adhere to change management requirements through compliance, legal, and operations for reporting, approval signatures, and maintenance of changes
  • Analyze and interpret coverage documents to assist in determining the best approach for the system configuration
  • Aid in the creation of test case scenarios, including regression test cases, to validate system configuration against source documentation
  • Coordinates with the Information Management Department to discuss the downstream impacts of the configuration set-up within the system
  • Tracks opportunities for documentation, reimbursement and coding improvement
  • Provides information and feedback daily on coding related issues, edits, denials, reimbursement trends, and coding errors to Operational Management and Medical Management
  • Developing and executing audit processes to find gaps in system configuration, as well as department policies and procedures.
  • Responsible for the training and development of other associates within the Configuration Team, including any cross-training with other areas as directed by management
  • Strong organizational skills and ability to manage multiple competing projects and deadlines
  • Ensures internal compliance with all Federal and State Regulations
  • Attend management meetings in place of Configuration Management as needed
  • Additional duties as assigned
Requirements:
  • Bachelor's degree in Business/Health Information Services, or equivalent configuration and/or coding experience strongly preferred
  • Five years of healthcare experience, with equivalent configuration and/or coding experience preferred; Managed Care experience preferred
  • Project Management experience strongly preferred
  • Analytical ability to organize and prioritize work to meet deadlines
  • Advanced proficiency in Microsoft Office (Word, Excel, Access, and Visio)
  • Ability to communicate effectively with excellent written and verbal skills required
  • Good judgment, initiative, and problem-solving abilities
  • Ability to prioritize and resolve complex issues with little assistance
  • Thorough understanding of ICD9-CM, ICD10, DRG methodologies, CPT-4, Outpatient Code Editor and National Correct Coding Initiative policies
  • Knowledge of Claim Check system or equivalent clinical editing systems preferred
  • Health Solutions Plus (HSP) experience preferred
  • X12 Experience
  • Must be able to obtain a Common Access Card (CAC) within 6 months of start date - Requires the complications of a Public Trust Background check, Fingerprint Check, and Credit Check
  • Medical Coding Certification strongly preferred
Work Type:

Full Time



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