Senior System Configuration Analyst

February 8

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Alignment Health

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Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

Medicare Advantage • Accountable care organization • Population health management • Medicare

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

💰 $135M Series C on 2020-03

📋 Description

• The Sr. Systems Configuration Analyst is responsible for maintaining all pricing and coding within the Managed Care System. • Collaborating with IT and Business to ensure accurate claims payment consistent with contract and Medicare guidelines. • Understands various types of reimbursement and contracting arrangements and/or benefits administration data elements that need to be configured in the Managed Care System for accurate claims payment. • Perform user acceptance testing to ensure system configuration accuracy. • Troubleshoot and resolves configuration-related issues, working closely with internal teams and external vendors as needed. • Analyze and interpret documents related to claim system configuration to ensure accurate system configuration.

🎯 Requirements

• Required: Minimum of 5 years hands-on experience in claims system configuration such as health plan benefits, provider pricing, authorization rules and/or DOFR. • Required: High School Diploma or GED • Preferred: Bachelor’s degree in Health Informatics or 5+ years hands-on experience in claim system configuration • Required: Demonstrated experience in managing complex system configurations, performing system audits and resolving configuration-related issues • Required: Familiarity with payer policies, provider contract terms and health plan benefits • Required: Strong analytical and effective problem-solving skills, with the ability to interpret complex healthcare documents and translating them to system requirements • Required: Excellent communication and interpersonal skills, with the ability to collaborate effectively with cross-functional teams • Required: Detail-oriented with exceptional organization skills and the ability to manage multiple tasks and projects simultaneously • Required: Working knowledge of healthcare coding systems such as ICD, CPT, HCPCS, revenue codes and other related codes. • Required: Knowledge of medical claims processing guidelines and different payment methodologies. • Required: Proficiency in data analysis and reporting tools such as SQL, Excel, or other healthcare-specific tools. • Required: Experience with medical claims systems such as Facets, pricing tools such as Optum PPS, and clinical claims editing softwares. • Required: In-depth knowledge of healthcare regulatory requirements including medical coding and Medicare pricers.