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Alliance Health · 2 days ago

Configuration Specialist-Core Systems (Full-Time Remote, North Carolina Based)

United States

Full-time

Remote

Mid, Senior Level

$82K/yr - $104K/yr

3+ years exp

Alliance Health is seeking a Configuration Specialist of Core Systems who will serve as a subject matter expert on core business functions and application configurations. The role involves workflow design, data management, and providing support for claims and eligibility software.

Health Care

Responsibilities

Responsible for configuration, data management, development of claims adjudication rules, workflows, and system parameters

Supports the customization of system modules based on business requirements e.g. benefit plans, provider contracts, and fee schedules

Supports the update of claim edits, code sets (ICD, CPT, HCPCS, NCCI), and other configurable elements

Provides development and support activities for the application, including collaboration with business analysts, product owners, and stakeholders to understand claims processing needs for the purpose of translating business requirements into technical configuration specifications

Reviews and participates in resolving issues with data loads, workflows, configurations, rule processing, etc

Analyzes proposed product design and configuration changes to determine the effect on the overall system and suggest appropriate alternatives and solutions

Has an extensive understanding of the business unit's function and can effectively communicate technical issues and solutions in non-technical terms to the business unit

Supports the configuration control process during product configuration, testing, and migration between environments, including business reviews and approvals

Provides advice and guidance on methods, procedures, and requirements to individuals responsible for creating documentation

Write and perform unit end-to-end testing and debugging—set test conditions based on code specifications

Able to analyze and debug complex data errors and provide resolutions as required

Validate testing outcomes to ensure alignment with business rules, requested enhancements, and regulatory compliance

Support User Acceptance Testing along with business users

Monitor claims processing performance and investigate configuration-related concerns

Identify and implement improvements to streamline claim workflows or increase accuracy

Assist in System upgrades, patches, and releases

Provide Tier 2 or Tier 3 support for configuration-related concerns escalated by the operations or system support teams

Remain up to date on healthcare regulations (HIPPA, CMS etc.) or insurance rules to ensure configurations remain compliant

Maintain clear documentation of configuration changes, test results, and system setups

Identify and document the functional and technical characteristics of the product configuration, provide the appropriate change control document, and report those changes

Provide version control and documentation of all element migrations between the various Application environments

Provide advice and guidance on methods, procedures and requirements to individuals responsible for the creation of documentation

Qualification

Claims processingApplication configurationData analysisHealthcare regulationsSDLC methodologiesAgile methodologiesTechnical writingMicrosoft OfficeMicrosoft VisioMicrosoft ProjectMicrosoft Visual StudioLeadership skillsOrganizational skillsProblem-solving skillsCommunication skills

Required

High School diploma or equivalent and five (5) years of experience in application support, including experience planning, facilitating, eliciting, documenting and managing business, functional and technical requirements

Graduation from a Community College or Technical School with a two-year degree in computer science, information technology, information science, human services, healthcare, or related field and three (3) years of experience in application support, including experience planning, facilitating, eliciting, documenting and managing business, functional and technical requirements

Knowledge of Software development and programming

Knowledge of data analysis on databases/data sets

Understanding of SDLC and Agile methodologies

Keen understanding of IT system design processes

Microsoft Office, Visio, Microsoft Project and Microsoft Visual Studio skills

Excellent facilitation and organizational skills

Strong critical thinking and problem-solving skills

Excellent written communication skills, including technical writing and document design principles

Ability to manage and work on multiple projects at the same time

Ability to think independently and contribute to projects

Strong leadership and people management skills, with the ability to inspire and motivate a team

Preferred

Bachelor's degree from accredited university in an information technology or related field and five (5) years of experience in business application consulting or development, including experience in planning, facilitating, eliciting, documenting and managing business, functional and technical requirements

Experience in Healthcare Insurance Claims, Encounters, or Enrollment processing and system configuration in an insurance or healthcare industry setting highly preferred