Configuration Analyst

GENERAL DESCRIPTION: Responsible for analyzing, configuring, and unit testing in Power MHS the parameters for all participants and non-participant providers’ contractual agreements and group benefit structures for both lines of business, to ensure the correct claims payments. ESSENTIAL FUNCTIONS: •Process configuration requests from the Claims Unit to add or modify parameters, benefit structures, and profit arrangements for providers and members within the system. •Analyze and troubleshoot claims issues, including Hold Codes, benefit discrepancies, rate inaccuracies, and system functionality errors to ensure correct claim adjudication. •Configure and maintain provider and facility rate structures using the Mass Pricing Application, ensuring data accuracy and pricing consistency. •Implement and maintain payment rules based on the Clinical departments' guidelines to ensure compliance with clinical and financial standards. •Set up and maintain system references and configurations (e.g., benchmarks, codes, and parameters) in the system to support operational efficiency. •Design, configure, and update benefit structures for new groups, renewals, and coverage changes across all lines of business. •Maintain Diagnostic and Service Class mappings in all relevant Map Sets to support accurate claims processing. •Support ClaimXten configuration by providing recommendations and implementing new settings to optimize payment accuracy and rule automation. •Prepare configuration documentation and unit test cases for new benefits, provider contracts, and system updates. •Execute and document unit testing for system updates, company initiatives, and Disaster Recovery Plan validation across all supported platforms. •Collaborate on project implementations by analyzing requirements, configuring system changes, and validating results for the company initiatives assigned. •Assist with internal and external audits by ensuring configuration accuracy, maintaining documentation, and providing data to support compliance reviews. ADDITIONAL FUNCTIONS: • Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices. • May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document. MINIMUM QUALIFICATIONS: Education and Experience: Bachelor's Degree in Business Administration in Business Information Technology, preferably or a related degree. At least two (2) years of experience in provider contract administration, system configuration, medical claims processing, and operations in the Healthcare industry. “Proven experience may be replaced by previously established requirements.” Certifications / Licenses: N/A Other: Knowledge of Power MHS. Knowledge of the healthcare Claims process. Knowledgeable of ICD-10, CPT, HCPCS, revenue codes, and medical terminology. Knowledge in querying data in SQL, Access, and Excel. Languages: Spanish – Intermediate (comprehensive, writing and verbal) English – Intermediate (comprehensive, writing and verbal)