Texas Children's Health Plan
Configuration Analyst
Texas Children's Health Plan, Bellaire, Texas, United States, 77401
Details
Client Name Texas Children's Health Plan Job Type Travel Offering Nursing Profession Executive Specialty Director Of Quality Management Job ID 29187056 Job Title Configuration Analyst Weekly Pay $700.0
Shift Details
Shift Day - 8x5 - 09AM Scheduled Hours 40
Job Order Details
Start Date 12/02/2024 End Date 03/15/2025 Duration 15 Week(s)
Job Description Job Title: Configuration Analyst
Job Specialty: Quality Audit
Job Duration: 15 Months
Shift: Hybrid - Monday to Friday, 8 AM to 5 PM
Guaranteed Hours: 40 Hours per Week
Experience: Minimum of 2 years in managed care, claims processing, and/or configuration of benefits/contracts/fee schedules/medical policy payment rules. A Bachelor's degree may substitute for the required work experience.
License: None specified
Certifications: At least one EPIC Tapestry certification strongly preferred
Must-Have: - Experience in Texas Medicaid - Claims Specialist or Claims Research Analyst experience - Experience working on adjustments/appeals - Tapestry Benefits or Tapestry Contracts configuration experience - Tapestry Certifications in Contracts or Benefits
Job Description:
- Maintain a strong understanding of areas under Med Policy Configuration, such as benefits, contracting, coding, fee schedules, or claim edits. - Responsible for system updates, new health plan implementations, and conversions within Business Operations. - Design configuration solutions to meet new business requirements and execute updates related to benefits, coding, contracts, fee schedules, or claim editing rules. - Analyze requests and design configuration solutions tailored to business requirements. - Implement configuration changes for coding, contracts, benefits, fee schedules, and claim editing rules as needed. - Create and execute testing scenarios to demonstrate the efficiency of configuration solutions. - Maintain thorough documentation for tracking changes related to Change Control Management or for quality audit purposes. - Ensure configuration changes meet quality standards and service level agreements. - Assist in the development of configuration standards and best practices. - Identify claims affected by configuration changes, generate reports, and coordinate reprocessing with claims administration. - Monitor pended claims and work queues to ensure systems are updated appropriately. - Escalate identified issues and recommend and implement configuration changes to enhance accuracy and process efficiency. - Handle varying work volumes, prioritize tasks to meet deadlines, and address user needs effectively.
Skills Required:
- Knowledge of managed care business practices and adjudication systems. - Working knowledge of the healthcare industry, particularly health insurance/managed care. - Effective collaboration, written and verbal communication, analytical and organizational skills. - Ability to manage time with competing priorities, self-motivation, leadership, and work independently with minimal supervision. - Understanding of claims processing, configuration of contracts, benefits, fee schedules, and Claims Editing System. - Ability to interpret business requirements into system coding edits and test configuration builds. - Required education: High School Diploma or GED - Language: Proficiency in English (Speak, Read, Write)
Client Details
Address 6330 W Loop S City Bellaire State TX Zip Code 77401
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Client Name Texas Children's Health Plan Job Type Travel Offering Nursing Profession Executive Specialty Director Of Quality Management Job ID 29187056 Job Title Configuration Analyst Weekly Pay $700.0
Shift Details
Shift Day - 8x5 - 09AM Scheduled Hours 40
Job Order Details
Start Date 12/02/2024 End Date 03/15/2025 Duration 15 Week(s)
Job Description Job Title: Configuration Analyst
Job Specialty: Quality Audit
Job Duration: 15 Months
Shift: Hybrid - Monday to Friday, 8 AM to 5 PM
Guaranteed Hours: 40 Hours per Week
Experience: Minimum of 2 years in managed care, claims processing, and/or configuration of benefits/contracts/fee schedules/medical policy payment rules. A Bachelor's degree may substitute for the required work experience.
License: None specified
Certifications: At least one EPIC Tapestry certification strongly preferred
Must-Have: - Experience in Texas Medicaid - Claims Specialist or Claims Research Analyst experience - Experience working on adjustments/appeals - Tapestry Benefits or Tapestry Contracts configuration experience - Tapestry Certifications in Contracts or Benefits
Job Description:
- Maintain a strong understanding of areas under Med Policy Configuration, such as benefits, contracting, coding, fee schedules, or claim edits. - Responsible for system updates, new health plan implementations, and conversions within Business Operations. - Design configuration solutions to meet new business requirements and execute updates related to benefits, coding, contracts, fee schedules, or claim editing rules. - Analyze requests and design configuration solutions tailored to business requirements. - Implement configuration changes for coding, contracts, benefits, fee schedules, and claim editing rules as needed. - Create and execute testing scenarios to demonstrate the efficiency of configuration solutions. - Maintain thorough documentation for tracking changes related to Change Control Management or for quality audit purposes. - Ensure configuration changes meet quality standards and service level agreements. - Assist in the development of configuration standards and best practices. - Identify claims affected by configuration changes, generate reports, and coordinate reprocessing with claims administration. - Monitor pended claims and work queues to ensure systems are updated appropriately. - Escalate identified issues and recommend and implement configuration changes to enhance accuracy and process efficiency. - Handle varying work volumes, prioritize tasks to meet deadlines, and address user needs effectively.
Skills Required:
- Knowledge of managed care business practices and adjudication systems. - Working knowledge of the healthcare industry, particularly health insurance/managed care. - Effective collaboration, written and verbal communication, analytical and organizational skills. - Ability to manage time with competing priorities, self-motivation, leadership, and work independently with minimal supervision. - Understanding of claims processing, configuration of contracts, benefits, fee schedules, and Claims Editing System. - Ability to interpret business requirements into system coding edits and test configuration builds. - Required education: High School Diploma or GED - Language: Proficiency in English (Speak, Read, Write)
Client Details
Address 6330 W Loop S City Bellaire State TX Zip Code 77401
Job Board Disclaimer
By applying for jobs on this website, you consent to receive daily messages from CYNET about assignments that match your profile. Email or text HELP for more info, or STOP to unsubscribe. Your mobile info will not be shared with third parties for marketing. Standard messaging and data rates may apply.