Tech Ops Configuration Analyst
Evolent Health LLC
Pune, Maharashtra, India
34d ago

Configuration Analyst

We are looking for motivated and engaged individuals to join the Tech Ops Configuration Team in Health Plan Services. If you have a penchant for detail, are a recent college graduate or have prior health insurance claims processing or configuration experience, we would like to talk with you! We will train the right candidates for this position.

Position Description :

  • Collaborate with business and technical teammates to resolve client production issues
  • Participate in problem solving of Health Plan benefit, provider, pricing, reporting, operational and system issues
  • Perform a variety of tasks related to the resolution of production support issues based on client configurations with the core administrative system
  • Potential to rotate through configuration support functions across key system areas and lines of business with the ability to develop subject matter expertise
  • Responsibilities :

  • Support the work to troubleshoot and resolve claims issues introduced by user, configuration, system or reporting errors;
  • working multiple issues simultaneously

  • Support activities to updateconfiguration within the core claims processing system,typically within the areas of Provider, Pricing or Benefit Plan / Adjudication Rules.
  • Potential responsibilities include and may vary by system area of assignment :

  • Updatecredentialing variables and demographics (credentialed and non-credentialed providers), contract or fee schedule assignment and network affiliation
  • Update group / benefit configuration including benefit plans (coinsurance, deductible, copay, out of pocket) and benefit plan rules
  • Support fee schedule changes including terms, affiliations and contract maintenance
  • Updates to general system configuration such as workflow, dictionary / master file updates (research, set up and maintenance of reference values (diagnosis codes, procedure codes, 835 CARC / RARC and other medical codes) and global settings, as necessary
  • Collaborate across IT and Operational departments to define and develop necessary technology or business processes to support process improvement initiatives
  • Job Requirements :

  • Education Requirements : Bachelor’s Degree or equivalent work experience
  • Ability to work collaboratively on team that includes all levels of organization and HealthPlan
  • Ability to communicate effectively yet concisely in both an oral and written manner
  • Analytical Skills necessary to independently discover and outline systems related issues
  • Ability to support projects and recommend / implement process for projectcompletion
  • Understanding of logic of standard medical coding manuals (i.e. CPT, ICD-10, HCPCS,etc.) and national billing guidelines (NUBC, NUCC)
  • Knowledge of medical claims adjudication andediting
  • Detailoriented
  • Beginner skill level of Microsoft Excel required; Intermediate skill level a plus
  • EDI X12 835, 837I & 837P knowledge a plus
  • Prior experience with Facets / RIMS, CSC or DST or a rules-based system a plus
  • Database table structure knowledge and SQL query writing capability a plus
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