Configuration Data Analyst Job San Jose area,California USA,IT/Tech

Configuration Data Analyst

Salary Range: $111,168 - $172,310
The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.

FLSA Status: Exempt

Department: Information Systems

Reports to: Manager, IT Configuration

Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521

GENERAL DESCRIPTION OF POSITION

The Configuration Data Analyst is responsible for system configuration, implementations and conversions of SCFHP's core systems. This position is responsible for the accurate interpretation and associated configuration of regulatory federal and state guidelines. along with business contractual agreements impacting benefits, contracts, millions of dollars in claims payment, case management, and/or grievance and appeals within core systems. The Configuration Data Analyst must have the ability to meet with internal and external business units and peers to gather requirements, independently analyze and mine data, draw sound conclusions, configure, test and implement the data structures that support SCFHP's managed care information system (s) required to meet business needs, regulatory compliance, and vendor contractual obligations.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Comprehensive understanding of capitation models in order to setup within our core system to support multiple delegate contracts averaging approximately 50 million dollars in monthly capitation payments, based on accurate setup and configuration.

Comprehensive understanding and ability to interpret simple and complex provider contracts and amendments in order to setup within our core system reimbursement for, but not limited to, hospitals, provider groups, ancillary providers averaging approximately 1 million dollars in weekly claim payments, based on accurate setup and configuration.

Comprehensive understanding and ability to interpret federal and state government (DHCS and CMS) guidelines, and eligibility and enrollment process in order to setup core systems for claims, case management, and grievance and appeals

Combine in-depth analysis of business unit requirements and comprehensive understand of core system capabilities, knowledge of claim processing, provider and vendor setup, authorizations and business processes in order to determine optimal core system setup to process claims, case management, and grievance and appeals with a high degree of accuracy and auto-adjudication.

Serve as a subject matter expert for multiple core systems including but not limited to QNXT, Essette, Beacon, Zipari, Networ

X, Optum CES (Claims Editing System), etc.

Troubleshoot small to large scale, basic to highly complex business and system production issues by thoroughly reviewing the issue, researching within internal and external documentation such as regulatory publications, and system user guides, performing analysis and critical thinking and testing in order to identify a root cause, document findings, and recommend solutions

Perform basic to highly complex system configuration and maintenance of system rules including but not limited to benefits, authorizations, contracts, fee schedules, DFRs, capitation, letter templates, etc. in order to fix production support issues, or support business needs and regulatory requirements in multiple system applications (such as QNXT, Essette, CES, etc.) for multiple lines of business.

Coordinate the loading, validation, and testing of third party software updates, rate changes, and code changes (CPT, Diagnosis, etc.) with business units and outside vendors, as needed.

Combine in-depth analysis of application configuration and data, information gathered through independent research, knowledge of system capabilities and interdependencies, and business processes to determine the best configuration in order to ensure overall accuracy and efficiency of system processing

Project and task management for small to large scale configuration projects including but not limited to:
Attend meetings with business units to gather requirements, track actionable items, send regular communications, elevate identified risks, recommend, implement, and test configuration changes.

Develop documentation of changes, system issues, defects, and bugs including formal requirements, functional specifications, step-by-step configuration setup, root cause, test results reflecting impact to affected business units, manager, and/or external third party vendors.

Perform unit testing and post audit to ensure quality, accuracy, and completeness of work.

Conduct post implementation internal review and analysis in order to refine system rules to further optimize configuration for greater efficiency and accuracy.

Assist in all aspects of new system and new line of business implementations and conversions, as well as core system updates.

Create and maintain basic to moderate SQL based to support business and system processes and initiatives.

Provide…


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