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Experience:
1-3 years of experience
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Employment Type:
Intern/Co-op
Posted:
4/15/2015
Job Category:
Information Services
Industry:
Health Care & Medicine
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Configuration Analyst III
Kaiser Permanente | Rancho Cucamonga, California
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Job Description

The Configuration Analyst will understand the types of provider contracting arrangements and/or benefits administration data elements that need to be configured in the existing application (the host processing system), and other platform applications to support the accurate and timely payment of claims for the Regions' Claims systems.  Tests new releases, makes recommendations on system enhancements, and evaluates contracts for configuration which includes system capabilities.  Consults with appropriate internal partners on issues of interpretation.  The Configuration Analyst works with the Product Managers and Developers to define, code, configure and maintain detailed provider/benefit services and provider/benefit plans designs for the applications that require benefit information.  The Configuration Analyst helps to bring products to market that meet customer (e.g., member, broker, consultant, employer, etc.) needs and expectations and ensures that product and operational goals are achieved.  The Configuration Analyst makes sure benefits are well defined and can be configured in all applications that require benefit data / provider contract data.
 
Essential Functions:
Performs Configuration Activities (which may include all or some of the following Institutional and Provider Contracts, Benefits Authorizations, and/or General Configuration such as System Edit Rules, Fee Schedules updates, etc.) in Diamond Claims Processing system or other system resulting in 100% accurate claim payments consistent with the contractual arrangement(s) made with the Provider, and according to the Groups Evidence of Coverage (EOC).
Leads business requirements development and solution design process including creation of requirements and design documentation and facilitating sessions with business owners and other team members).
Maintains detailed knowledge and understanding of the host Claims processing system rules relative to claims payment. 
Coordinates, researches, and resolves debarred and sanctioned provider data and ensures communication of required system updates to Provider Contracting and Claims Operations.
Conducts preliminary evaluation of contractual agreement prior to execution to determine system configurability. 
Conducts systems requirement assessment in support of regulatory changes (e.g. ICD-10, ASC, DRG etc).
Analyzes business requirements to determine the best approach for configuration design, testing and implementation.
Analyzes benefit evidence of coverage to determine best approach for loading benefits plan offered including co-pays, out-of-pocket maximums and state/regulatory benefits coverage.
Develops, documents, and executes test plans for configuration testing and validates accuracy of data loaded.
Acts as the liaison between business configuration and business owners to ensure that all application and technical-oriented issues relating to the configuration requests/projects are appropriately addressed.
Writes/generates ad-hoc claims impact reports and compiles reconciliation statements. 
Tests new version releases relative to system configuration and documents results.
Analyzes and make recommendations to management regarding system enhancements and communicates system problems and impact on operations.
Acts as the subject matter expert regarding Configuration Activities for cross-regional/national initiatives.
Assumes other duties as directed.
The Configuration Analyst will understand the types of provider contracting arrangements and/or benefits administration data elements that need to be configured in the existing application (the host processing system), and other platform applications to support the accurate and timely payment of claims for the Regions' Claims systems.  Tests new releases, makes recommendations on system enhancements, and evaluates contracts for configuration which includes system capabilities.  Consults with appropriate internal partners on issues of interpretation.  The Configuration Analyst works with the Product Managers and Developers to define, code, configure and maintain detailed provider/benefit services and provider/benefit plans designs for the applications that require benefit information.  The Configuration Analyst helps to bring products to market that meet customer (e.g., member, broker, consultant, employer, etc.) needs and expectations and ensures that product and operational goals are achieved.  The Configuration Analyst makes sure benefits are well defined and can be configured in all applications that require benefit data / provider contract data.
 
Essential Functions:
Performs Configuration Activities (which may include all or some of the following Institutional and Provider Contracts, Benefits Authorizations, and/or General Configuration such as System Edit Rules, Fee Schedules updates, etc.) in Diamond Claims Processing system or other system resulting in 100% accurate claim payments consistent with the contractual arrangement(s) made with the Provider, and according to the Groups Evidence of Coverage (EOC).
Leads business requirements development and solution design process including creation of requirements and design documentation and facilitating sessions with business owners and other team members).
Maintains detailed knowledge and understanding of the host Claims processing system rules relative to claims payment. 
Coordinates, researches, and resolves debarred and sanctioned provider data and ensures communication of required system updates to Provider Contracting and Claims Operations.
Conducts preliminary evaluation of contractual agreement prior to execution to determine system configurability. 
Conducts systems requirement assessment in support of regulatory changes (e.g. ICD-10, ASC, DRG etc).
Analyzes business requirements to determine the best approach for configuration design, testing and implementation.
Analyzes benefit evidence of coverage to determine best approach for loading benefits plan offered including co-pays, out-of-pocket maximums and state/regulatory benefits coverage.
Develops, documents, and executes test plans for configuration testing and validates accuracy of data loaded.
Acts as the liaison between business configuration and business owners to ensure that all application and technical-oriented issues relating to the configuration requests/projects are appropriately addressed.
Writes/generates ad-hoc claims impact reports and compiles reconciliation statements. 
Tests new version releases relative to system configuration and documents results.
Analyzes and make recommendations to management regarding system enhancements and communicates system problems and impact on operations.
Acts as the subject matter expert regarding Configuration Activities for cross-regional/national initiatives.
Assumes other duties as directed.

Qualifications

Basic Qualifications:
Four (4) to six (6) years experience as a configuration analyst.
Minimum of three (3) years in healthcare or managed care.
Three (3) to five (5) years of customer service experience preferred.
Experience interpreting and relaying Kaiser Permanente Health Plan benefits and service preferred.
Experience with Center for Medicaid and Medicare (CMS) regulatory guidelines preferred.
Bachelor's degree in Information Systems, Business or Health Care Administration, or other related field, preferred.
Expert knowledge in Claims / Provider contracts / Authorization / benefits administration in Diamond. 
Understanding of relational databases.
Significant experience in documentation, research and reporting required.
Excellent interpersonal, communication, and listening skills are required.
Demonstrated competency in medical coding, medical terminology, claims processing, logical thinking and understanding of relational database is required. 
Knowledge of state and federal regulations.
Strong critical thinking and analysis skills; verbal and written communications, and interpersonal interactions (e.g. partnering, conflict management, consulting, etc.).
Advanced proficiency in Microsoft Excel.
Maintains current knowledge of performance tracking and quality improvement literature, and research projects.
Maintains thorough knowledge of technology resources available to the NCSS.
Intermediate proficiency in Microsoft Access and Query Tools preferred.
Basic proficiency in Statistical analysis preferred.
Basic Qualifications:
Four (4) to six (6) years experience as a configuration analyst.
Minimum of three (3) years in healthcare or managed care.
Three (3) to five (5) years of customer service experience preferred.
Experience interpreting and relaying Kaiser Permanente Health Plan benefits and service preferred.
Experience with Center for Medicaid and Medicare (CMS) regulatory guidelines preferred.
Bachelor's degree in Information Systems, Business or Health Care Administration, or other related field, preferred.
Expert knowledge in Claims / Provider contracts / Authorization / benefits administration in Diamond. 
Understanding of relational databases.
Significant experience in documentation, research and reporting required.
Excellent interpersonal, communication, and listening skills are required.
Demonstrated competency in medical coding, medical terminology, claims processing, logical thinking and understanding of relational database is required. 
Knowledge of state and federal regulations.
Strong critical thinking and analysis skills; verbal and written communications, and interpersonal interactions (e.g. partnering, conflict management, consulting, etc.).
Advanced proficiency in Microsoft Excel.
Maintains current knowledge of performance tracking and quality improvement literature, and research projects.
Maintains thorough knowledge of technology resources available to the NCSS.
Intermediate proficiency in Microsoft Access and Query Tools preferred.
Basic proficiency in Statistical analysis preferred.

About Kaiser Permanente

Company Description

Serving approximately 8.7 million members in nine states and the District of Columbia, Kaiser Permanente is America's leading nonprofit integrated health plan.

Kaiser Permanente's mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve.

Our Northern California Region provides integrated health care services to approximately 3.2 million members. Approximately 4,400 physicians of The Permanente Medical Group provide services at 20 medical centers and numerous medical offices.

Company History

Founded in 1945, Kaiser Permanente is the nation’s largest not-for-profit health plan, serving more than 8.6 million members, with headquarters in Oakland, Calif. It comprises:

  1.   • Kaiser Foundation Health Plan, Inc.

  • Kaiser Foundation Hospitals and their subsidiaries

  • The Permanente Medical Groups.

At Kaiser Permanente, physicians are responsible for medical decisions. The Permanente Medical Groups, which provide care for Kaiser Permanente members, continuously develop and refine medical practices to help ensure that care is delivered in the most efficient and effective manner possible.

Kaiser Permanente’s creation resulted from the challenge of providing Americans medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Among the innovations it has brought to U.S. health care are:

  • prepaid health plans, which spread the cost to make it more affordable

  • physician group practice to maximize their abilities to care for patients

  • a focus on preventing illness as much as on caring for the sick

  • an organized delivery system, putting as many services as possible under one roof

Mission & Values

As a health care organization in the 21st century, we have a mission--to provide quality care for our members and their families, and to contribute to the well-being of our communities.

Working Here

When you bring your career to Kaiser Permanente, the work you do directly affects the health of millions. From the business people who shape our policies, to the IT professionals enabling life-saving data, to the nurses and physicians on the front line of patient care, everyone here has a role to play in the care continuum. Knowing you have a place in that process and witnessing the outcome of the work you do is empowering. It gives you a cause to stand behind. And it makes you feel proud of the work you do every day. When people witness the impact of their contributions, they excel. Together we have the power to make a difference.

Hiring Information

The first step in beginning your career search is to look for open jobs that match your skills, qualifications, and interests. Each posting includes a description of the position and the minimum required qualifications. Once you find a position you are interested in, register for an account and provide your information for consideration online.

Benefits

As an employee, you are eligible for benefits according to your full-time/part-time status and the number of hours scheduled to work per week. Benefits may vary based on your Kaiser Permanente region, position, scheduled hours, and representation by collective bargaining or employee groups, but generally include:

  • generous vacation, holiday, and sick leave

  • medical care (including prescriptions), vision, mental health, and dental care

  • disability and life insurance coverage

  • educational opportunities and tuition reimbursement

  • employee assistance programs

  • health care, dependent care, and transit spending account options

  • retirement plans

In addition, we believe in recognizing stellar performance and sponsor a variety of programs designed to reward our skilled, innovative, caring, and committed staff.

In short, at Kaiser Permanente, we understand that there is a direct correlation between happy employees and happy members. We take pride in the compassion and dedication of our employees and find many ways to reward their hard work. In return, our employees take pride in being a part of a collaborative, professional team focused on quality, service, and care.

Honors & Awards

Kaiser Permanente of Northern California has earned an "Excellent" rating from the National Committee for Quality Assurance (NCQA)-the nation's leading reviewer of health plan quality for consumers and employers. Excellent is the top rating granted by NCQA, which reviews satisfaction surveys, preventive measures, physician credentialing, member services and improvement initiatives.*

Both our Northern and Southern California regions were the only health plans in California identified by the NCQA in its list of the best health care programs in the Pacific States. (NCQA's The State of Health Care Quality 2003)

The Joint Commission on Accreditation of Healthcare Organizations accredits all Kaiser Foundation Hospitals in California.

For the seventh straight year, no other health plan has earned higher ratings from the California Cooperative Health Reporting Initiative on more measures than Kaiser Permanente. The annual ratings measure clinical quality and member satisfaction. (CCHRI Report on Quality 2003)

Our Northern California region received more three-star "Excellent" ratings than any other health plan surveyed by California's Office of the Patient Advocate on California's Quality of Care Report Card 2003-04.

* Commercial HMO and Medicare-contracted product lines: April 2003.