Claims Systems Configuration Analyst
Assists in the configuration and maintenance of the claims system used to
administer operations of current and new business for VNSNY CHOICE products.
Translates business rules to action. Analyzes, documents, and tests all new
configurations. Assists in preparing and delivering reports, recommendations,
and updates/revisions to address existing and potential issues in related
processes across the organization.
* Assists in the completion of system configuration in accordance with
contractual agreements and implements into production. Provides support
in all phases of the systems project life cycle including monitoring
project tasks, documentation of requirements, testing, training and roll
* Works with Compliance to identify new state and federal regulations and
ensures system configurations comply with CMS standards and DOH
regulations. Develops/updates audit programs to ensure product and
* Collaborates with internal departments and external vendors to ensure
that annual benefit updates and pricing configurations are mapped,
tested, documented, and loaded into production prior to the effective
date of the contract. Ensures that fees and coverage rules are
implemented annually or more often if dictated by regulating body.
* Validates that codes (CPT, HCPC, ICD Diagnosis, ICD Procedure) are
mapped, tested, documented, and loaded into production annually, prior to
the effective date of the coding group. Completes updates periodically as
deemed appropriate by regulating body.
* Maintains current versions of Benefit Grids for all VNSNY CHOICE
products. Disseminates communication on implementation of benefit changes
and new benefits to staff.
* Provides support in ensuring that pricing software is updated regularly,
tested, logged, and functioning properly in production.
* Assists in the development of reports and analyzes data to research/
correct discrepancies. Monitors post-implementation reports to identify
and fix configuration issues.
* Assists in the coordination, maintenance and development of various
technical processes (such as EDI, check processing, EOB) as they relate
to system configuration.
Education: Associate s degree in Business Administration, Healthcare
Administration, a related field or the equivalent work experience required.
Master s degree in related field preferred.
Experience:Minimum of three years managed health care operations experience
required. Experience with health care information system development required.
Experience managing complex projects across departments required. Effective
communication skills, both written and oral, and proficiency in PC software
applications (i.e. Microsoft Office) required.
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