Configuration Analyst II

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue.

With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen-not dilute-our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

The Configuration Analyst II supports implementation, maintenance, and governance of SCAN Health Plan’s Benefit Configuration, including Prior Authorization (PA) and Pre-Determination (PD) code sets. This role ensures approved code sets are accurately and timely configured across claims, utilization management, and related operational systems. The Configuration Analyst II partners with Medical Policy, Utilization Management, Configuration, Information Technology, delegated entities, providers, and vendors to support configuration, reporting, data analysis, system maintenance, and process improvement activities.

• Maintains PA and PD code sets across claims, utilization management, and related operational systems.
• Supports benefit configuration and prior authorization activities, including configuration, testing, validation, deployment, and post implementation review.
• Serves as a technical liaison for PA and PD configuration activities with internal teams, delegated entities, providers, and vendors.
• Troubleshoots and resolves benefits and authorization-related configuration issues, technical inquiries, and system problems impacting operational workflows.
• Supports Annual Enrollment Period (AEP) readiness by completing assigned benefit configuration activities, validating configuration accuracy, and meeting established implementation timelines.
• Analyzes data to identify trends, risks, process improvement opportunities, and operational or financial impacts.
• Supports continuous improvement initiatives by enhancing workflows, reporting capabilities, data quality, system functionality, and operational efficiency.
• Creates and maintains procedures, workflow documentation, training materials, and other resources supporting PA and PD list operations.
• Maintains knowledge of healthcare coding standards, authorization processes, CMS regulations, healthcare technology, and related best practices.

Bachelor's Degree or equivalent experience in Healthcare Administration, Health Information Management, Information Systems, Data Analytics, Business, Computer Science, or related field. 2 or more years of experience in healthcare systems, operations, analytics, medical coding, utilization management, or related technical functions. 2 or more years of experience with reporting, data analysis, SQL, or healthcare-related data. Experience working with healthcare coding systems, code set maintenance, or authorization-related processes.

Knowledge of healthcare coding systems, including CPT®, HCPCS, and related code sets. Understanding of healthcare claims processing, utilization management, authorization workflows, and healthcare operations. Knowledge of CMS regulations and Medicare Advantage and Medicaid program requirements preferred. Strong analytical and problem-solving skills, including data interpretation, issue identification, root cause analysis, and solution development. Proficiency in data analysis, reporting, performance measurement methodologies, SQL, reporting tools, and business intelligence platforms preferred.

QNXT experience is required. Proficiency with Microsoft Office Suite and related business productivity applications. Excellent written and verbal communication skills with the ability to explain technical concepts to technical and…