Projé Inc · 16 hours ago
HealthRules Payer Lead Configuration Analyst
Cypress, TX
Full-time
Hybrid
Senior Level
5+ years expProjé, Inc. is a woman-owned consulting firm providing advisory consulting services in the health care industry. The Lead HealthRules Payer Configuration Analyst will lead the configuration design, system changes, and quality assurance testing for HealthRules Payer implementations.
Professional Services
Responsibilities
Provides configuration strategy and design for one or more of these HRP functional areas, enrollment, billing, claims, finance, provider, medical management (GuidingCare) and benefits for an HRP implementation
Provides key advice, support and assistance to support technical and business requirements for respective functional areas mentioned above
Uses extensive HRP configuration business knowledge, and effective communication skills to lead, facilitate, and elicit requirements for projects
Ensures deliverables are on track and escalates any project related issues to Functional Domain Project Manager or Lead
Assists with the analysis and documentation of current and future states, defining user requirements in the design of the future state workflows, to optimize system functionality
Develops business process artifacts (configuration design documents, process flow, work state diagrams, etc.) as they pertain to enterpriselevel processes, spanning multiple functional areas. Documents and implements configuration and process improvements and control documentation
Reviews change requests to ensure consistency and compatibility to existing systems and procedures, including researching, validating, and resolving issues for accurate processing. Identifies, communicates, documents, and escalates information from all levels (endusers to leadership)
Troubleshoots configuration and technical issues, and identifies modifications needed to meet changing user and regulatory requirements
Assists in the education and training of endusers. Supports development of expert users, and mentors inexperienced users
Manages and facilitates meetings and presentations effectively and professionally to report progress and any issues
Prioritizes, plans, and organizes with Program Functional Lead and other Functional Leads to ensure cohesive enterprise configuration design and that highquality results are completed on time and within budget
Participates in Change Control process within Functional Domain
Routinely reports progress and issues/risks to Functional Domain Project Manager and Program Functional Lead
Responsible for functional requirement traceability between requirements gathered, design documents, workflows, and configuration workbook
Qualification
Required
Experience with prior HRP implementations and/or conversion is required
Hands on experience configuring HRP in one or more functional area including enrollment, billing, claims, finance, provider, medical management (GuidingCare) and benefits is required
Experienced in eliciting requirements from business users to define and document project requirements, with the ability to perform business analysis and translate the outcome into definable software functionality
Knowledge of computer software systems and applications and database setup and management. Expert in the use of Word, Excel, Visio, and other tools used for documentation and reporting purposes including MS Excel, MS Access, Crystal Reports and Microsoft Project (or other related project management software)
Meticulous attention to detail. Strong analytical, problem solving, negotiation, and collaboration skills, based upon goal and results orientation. Process driven, with proven ability to plan and execute multiple concurrent projects
Superb written and verbal English language communication skills, as well as interpersonal skills; able to communicate and influence peers, directors, and executives; to set clear expectations and realistic goals. Expert in the presentation of configuration ideas, status, solutions, and results
Superior task management skills, with the ability to work under pressure, independently, or as part of a team in situations in which multiple priorities are likely
Experience required in all or most of the following: Medicaid, Medicare Advantage, Healthcare Exchange/Marketplace, EDI transactions, Health Rules Payor experience including technical knowledge of supporting databases
Health plan operations experience is required
5 years or more of HRP Configuration experience required in one or more of the following areas: Enrollment, billing, claims, finance, provider, medical management (GuidingCare) and benefits
Associates or Bachelor's Degree in Information Management or comparable work-related experience
Hands on experience configuring HRP and HRP system implementation or conversion required
Benefits
Competitive pay and bonuses
Excellent benefits (medical, dental, vision)
401K with percentage company match
Paid holidays and vacation days
Flexible schedule
Company
Projé Inc
Projé, Inc.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase