HealthRules Payer Lead Configuration Analyst

Overview

Projé, Inc. is a woman-owned consulting firm providing advisory consulting services, project management, and analytical business resources in the health care industry. As a trusted advisor, Projé provides the knowledge, skills, and leadership to help clients achieve their goals. Projé offers a strong team-centered culture, focused on meeting project deliverables with excellence.

Projé has an exciting opportunity for a full-time Lead Health Rules Payer (HRP) Configuration Analyst. The Lead HRP Configuration Analyst will play an essential role in our clients’ Health Rules Payer Implementation by leading the configuration design, system changes, and quality assurance testing for the functional areas within HRP and the health plan. Under the leadership of the Program Functional Lead, this role will work with the Project team to gather and document requirements;

create configuration design documents, analyze existing data to identify areas of improvement, and lead testing in their assigned functional area. This role requires hands-on configuration experience in HRP as well as prior experience in an HRP implementation or system conversion. This individual should also be able to provide high-level configuration design strategy for HRP due to their expertise in the system and health plan operations.

• Provides configuration strategy and design for one or more of these HRP functional areas, enrollment, billing, claims, finance, provider, medical management (Guiding Care) and benefits for an HRP implementation.
• Provides ley advice, support and assistance to support technical and business requirements for respective functional areas mentioned above.
• Uses extensive HRP configuration business knowledge, and effective communication skills to lead, facilitate, and elicit requirements for projects.
• Ensures deliverables are on track and escalates any project related issues to Functional Domain Project Manager or Lead.
• Assists with the analysis and documentation of current and future states, defining user requirements in the design of the future state workflows, to optimize system functionality.
• Develops business process artifacts (configuration design documents, process flow, work state diagrams, etc.) as they pertain to enterprise level processes, spanning multiple functional areas. Documents and implements configuration and process improvements and control documentation.
• Reviews change requests to ensure consistency and compatibility to existing systems and procedures, including researching, validating, and resolving issues for accurate processing. Identifies, communicates, documents, and escalates information from all levels (endusers to leadership).
• Troubleshoots configuration and technical issues, and identifies modifications needed to meet changing user and regulatory requirements.
• Assists in the education and training of endusers. Supports development of expert users, and mentors inexperienced users.
• Manages and facilitates meetings and presentations effectively and professionally to report progress and any issues.
• Prioritizes, plans, and organizes with Program Functional Lead and other Functional Leads to ensure cohesive enterprise configuration design and that high-quality results are completed on time and within budget.
• Participates in Change Control process within Functional Domain.
• Routinely reports progress and issues/risks to Functional Domain Project Manager and Program Functional Lead.
• Responsible for functional requirement traceability between requirements gathered, design documents, workflows, and configuration workbook.

• Experience with prior HRP implementations and/or conversion is required.
• Hands on experience configuring HRP in one or more functional area including enrollment, billing, claims, finance, provider, medical management (Guiding Care) and benefits is required.
• Experienced in eliciting requirements from business users to define and document project requirements, with the ability to perform business analysis and translate the outcome into definable software functionality.
• Knowledge of computer software systems and applications and database setup…