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Experience:
No experience
Employment Type:
Intern/Co-op
Posted:
12/7/2015
Job Category:
Health Care Provider
Industry:
Health Care & Medicine
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Configuration Analyst
Kaiser Permanente | Oakland, California
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Job Description

The HPSC Configuration Analyst (CA) is responsible for Analysis, Design, Build and Unit Testing of Provider Contracts and Benefits within the KPCC Platform, to ensure accurate and timely claims payment consistent with the Regional and National artifacts (e.g. contractual arrangement(s) made with the Providers, Employer Groups etc). The HPSC Configuration Analyst understands the types of provider contracting arrangements and/or benefits administration data elements that need to be configured in KPCC platform applications to support the accurate and timely payment of claims. Uses Configuration Design templates to create and maintain artifacts (e.g. Build Worksheets to be used as documentation/specifications for "Certification or National Testing Teams"). Consults appropriate internal partners on issues of interpretation/clarity. Performs other duties as assigned by Management.

 

Essential Functions:
Utilizes predefined Design Templates and Processes to Configure simple functions such as Professional Providers or Simple Benefits.
Performs analysis of non-complex Contracts/Benefits.
Creates and maintains Configuration artifacts for non-complex Contracts/Benefits.
Consults with Regional or National Contract Manager, and other team members as needed.
Performs Provider Demographic (NPI, taxonomy, NPI Type, address) as needed.
Ensures the provider, authorization and benefits configuration meets established business rules and procedures.
Modifies the provider contract, authorization rules and benefit plan configuration as required.
Loads new contracts/ authorization/ benefit configuration in KPCC Platform.
Uses workflow to monitor contract updates and contract(s) matrix/grid.
Performs problem resolution of configuration issues.
Consults with relevant Contract Manager or business analyst to determine appropriate interpretation and configuration of contract terms.
Maintains detailed knowledge and understanding of KPCC Platform rules relative to claims payment.
Analyzes provider contracts to determine the best approach for loading data elements into the claim processing system.
Analyzes benefit explanation of coverage to determine best approach for loading benefits plan offered including co-pays, out-of-pocket maximums and state/regulatory benefits.
Analyzes medical management requirement to determine best approach for loading authorization rules into the claims processing system.
Develops, documents and executes test plans for configuration testing and validate accuracy of data loaded.
Performs problem resolution of configuration issues and documents results for the repository.
Coordinates research and resolution of debarred and sanctioned providers and ensures communication of required system updates to Provider Contracting and Claims Operations.
Conducts research and resolution of claim match rules and authorization rules and communicates required system updates to Medical Management.
Travels for team meetings up 10% of the time.

The HPSC Configuration Analyst (CA) is responsible for Analysis, Design, Build and Unit Testing of Provider Contracts and Benefits within the KPCC Platform, to ensure accurate and timely claims payment consistent with the Regional and National artifacts (e.g. contractual arrangement(s) made with the Providers, Employer Groups etc). The HPSC Configuration Analyst understands the types of provider contracting arrangements and/or benefits administration data elements that need to be configured in KPCC platform applications to support the accurate and timely payment of claims. Uses Configuration Design templates to create and maintain artifacts (e.g. Build Worksheets to be used as documentation/specifications for "Certification or National Testing Teams"). Consults appropriate internal partners on issues of interpretation/clarity. Performs other duties as assigned by Management.

 

Essential Functions:
Utilizes predefined Design Templates and Processes to Configure simple functions such as Professional Providers or Simple Benefits.
Performs analysis of non-complex Contracts/Benefits.
Creates and maintains Configuration artifacts for non-complex Contracts/Benefits.
Consults with Regional or National Contract Manager, and other team members as needed.
Performs Provider Demographic (NPI, taxonomy, NPI Type, address) as needed.
Ensures the provider, authorization and benefits configuration meets established business rules and procedures.
Modifies the provider contract, authorization rules and benefit plan configuration as required.
Loads new contracts/ authorization/ benefit configuration in KPCC Platform.
Uses workflow to monitor contract updates and contract(s) matrix/grid.
Performs problem resolution of configuration issues.
Consults with relevant Contract Manager or business analyst to determine appropriate interpretation and configuration of contract terms.
Maintains detailed knowledge and understanding of KPCC Platform rules relative to claims payment.
Analyzes provider contracts to determine the best approach for loading data elements into the claim processing system.
Analyzes benefit explanation of coverage to determine best approach for loading benefits plan offered including co-pays, out-of-pocket maximums and state/regulatory benefits.
Analyzes medical management requirement to determine best approach for loading authorization rules into the claims processing system.
Develops, documents and executes test plans for configuration testing and validate accuracy of data loaded.
Performs problem resolution of configuration issues and documents results for the repository.
Coordinates research and resolution of debarred and sanctioned providers and ensures communication of required system updates to Provider Contracting and Claims Operations.
Conducts research and resolution of claim match rules and authorization rules and communicates required system updates to Medical Management.
Travels for team meetings up 10% of the time.

Qualifications

Basic Qualifications:
Experience
Minimum one (1) year of experience in health insurance or managed care environment or equivalent education/experience such as in claims adjudication with knowledge of at least one of the following: membership, benefits, provider contracts & pricing, medical reviews, referral authorizations and code review and fee schedules.
Education
Two (2) years post high school educational training OR a minimum two (2) years of experience in directly related field (business, health care or other applicable field).
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
N/A
 
Additional Requirements:
Proficiency* in at least one (1) Tapestry Module (e.g. Core , AP) within six (6) months of hire. Rrequires a minimum of 75% exam score with a 100% score on the associated projects.
Both, Certification and Proficiency levels must be achieved within three times of completing testing. If certification/proficiency is a requirement of the position, the individual must pass the application test by the third try. If not, consequences include termination or transition to a different role.
Training and testing may be delivered at Epic or KP Facility.
Familiarity in Healthcare provider contract concepts and common claims adjudication practices and General Health plan functions.
Intermediate proficiency in Excel.
Familiarity MS Office Suite of products.
Demonstrated ability to research and analyze simple problems.
Experience in documentation, research and reporting.
Analytical and problem solving skills.
Excellent interpersonal, communication & listening skills.
Familiarity in healthcare benefits, benefit administration and health care delivery from either/both a payor or provider perspective, EDI and paper claim lifecycle, along with health insurance industry practices and standards.
 

Preferred Qualifications:

Certification** in more than one (1) Tapestry module preferred. **requires a minimum of 80% exam score with a 100% score on the associated projects.
Knowledgeable of state and federal regulations.
Beginner's proficiency in Access and Query tools.
Knowledge of Kaiser Permanente Internal processes.
Knowledge of Epic Tapestry Modules.

Basic Qualifications:
Experience
Minimum one (1) year of experience in health insurance or managed care environment or equivalent education/experience such as in claims adjudication with knowledge of at least one of the following: membership, benefits, provider contracts & pricing, medical reviews, referral authorizations and code review and fee schedules.
Education
Two (2) years post high school educational training OR a minimum two (2) years of experience in directly related field (business, health care or other applicable field).
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
N/A
 
Additional Requirements:
Proficiency* in at least one (1) Tapestry Module (e.g. Core , AP) within six (6) months of hire. Rrequires a minimum of 75% exam score with a 100% score on the associated projects.
Both, Certification and Proficiency levels must be achieved within three times of completing testing. If certification/proficiency is a requirement of the position, the individual must pass the application test by the third try. If not, consequences include termination or transition to a different role.
Training and testing may be delivered at Epic or KP Facility.
Familiarity in Healthcare provider contract concepts and common claims adjudication practices and General Health plan functions.
Intermediate proficiency in Excel.
Familiarity MS Office Suite of products.
Demonstrated ability to research and analyze simple problems.
Experience in documentation, research and reporting.
Analytical and problem solving skills.
Excellent interpersonal, communication & listening skills.
Familiarity in healthcare benefits, benefit administration and health care delivery from either/both a payor or provider perspective, EDI and paper claim lifecycle, along with health insurance industry practices and standards.
 

Preferred Qualifications:

Certification** in more than one (1) Tapestry module preferred. **requires a minimum of 80% exam score with a 100% score on the associated projects.
Knowledgeable of state and federal regulations.
Beginner's proficiency in Access and Query tools.
Knowledge of Kaiser Permanente Internal processes.
Knowledge of Epic Tapestry Modules.

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.