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IEHP · 1 week ago

Analyst II - Product System Configuration

Rancho Cucamonga, CA

Full-time

Hybrid

Mid Level

$80K/yr - $106K/yr

4+ years exp

IEHP is dedicated to healing and inspiring the human spirit, and they are seeking an Analyst II – Product System Configuration to manage complex system configurations within the Business System. This role involves interpreting guidelines, translating them into configurable parameters, and facilitating communication across departments while serving as a subject matter expert.

Health CareHealth DiagnosticsHospital

Comp. & Benefits

Responsibilities

Managing the more complex system configurations within the Business System

Accurate interpretation of state, federal, and contractual guidelines related to benefits, fee schedules, contracts, division of financial responsibility (DOFR), codification of services, and business requirements

Translating guidelines into configurable parameters within the Business Systems

Developing and maintaining comprehensive documentation of business and technical specification requirements utilizing best practice configuration guidelines

Facilitating communication and formally reporting findings to various department heads and staff

Training and helping educate other team members within the unit as necessary

Qualification

System configurationManaged care operationsMedicareMedi-Cal knowledgeCPT coding knowledgeRelational database structureMicrosoft ExcelProblem solvingCritical thinkingPresentation skillsWritten communicationTime management

Required

Four (4) years of experience with the development and remediation of moderately complex system configurations, including capitated provider agreement configurations

Bachelor's degree from an accredited institution required

+ In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position: two (2) years of general healthcare experience plus two (2) years of configuration experience is required

Knowledge of Medicare and Medi-Cal fee schedules and benefit structure, and regulatory billing guidelines required

Extensive knowledge of general managed care operations required

Basic knowledge of relational database structure

Exceptional problem solving and critical thinking skills

Strong presentation and written communication skills

Ability to work independently and solve complex problems with little to no assistance

Ability to effectively manage multiple competing priorities

Preferred

Experience in major managed care system migration/implementation

Knowledge of CMS, DHCS, DMHC, NCQA rules and regulations

Extensive knowledge of CPT, HCPCS, Revenue, ICD10 coding rules and guidelines

Delegated plan model

Advanced knowledge of Product System algorithms and processes

Familiar with basic medical product processing

Skilled in the use of Microsoft Excel and Access

Benefits

Telecommute schedule

State of the art fitness center on-site

Medical Insurance with Dental and Vision

Life, short-term, and long-term disability options

Career advancement opportunities and professional development

Wellness programs that promote a healthy work-life balance

Flexible Spending Account – Health Care/Childcare

CalPERS retirement

457(b) option with a contribution match

Paid life insurance for employees

Pet care insurance

Company

IEHP

Glassdoor3.8

With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans, the largest not-for-profit Medicare-Medicaid public health plan in the country, and for the fourth year in a row, certified as A Great Place To Work®.

Founded in 1995

Rancho Cucamonga, California, USA

1001-5000 employees