Analyst II - Product System Configuration - Rancho Cucamonga California

Company: Inland Empire Health Plan
Location: Rancho Cucamonga, California
Posted On: 04/15/2024

What you can expect!Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience!Under the direction of the Supervisor of Product System Configuration, the Analyst II - Product System Configuration is responsible for managing the more complex system configurations within the Business System. The primary functions of this position include but are not limited to, 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 and translating them into configurable parameters within the Business Systems. The Analyst II - Product System Configuration is independent and acts as a subject matter expert for the business areas by helping to drive decisions related to system configuration. The incumbent will develop and maintain comprehensive documentation of business and technical specification requirements utilizing best practice configuration guidelines developed by the Application Architects within the unit. The Analyst II - Product System Configuration will facilitate communication and formally report findings to various department heads and staff in a manner that is appropriate to the skill level and technical expertise of the audience. This position will be required to train and help educate other team members within the unit as necessary.PerksIEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.CalPERS retirement457(b) option with a contribution matchGenerous paid time off- vacation, holidays, sickState of the art fitness center on-siteMedical Insurance with Dental and VisionPaid life insurance for employees with additional optionsShort-term, and long-term disability optionsPet care insuranceFlexible Spending Account - Health Care/ChildcareWellness programs that promote a healthy work-life balanceCareer advancement opportunities and professional developmentCompetitive salary with annual merit increaseTeam bonus opportunitiesEducation & ExperienceFour (4) years of experience with the development and remediation of moderately complex system configurations, including capitated provider agreement configurationsBachelor's degree from an accredited institution requiredIn lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this positiontwo (2) years of general healthcare experience plus two (2) years of configuration experience is requiredKey QualificationsKnowledge of Medicare and Medi-Cal fee schedules and benefit structure, and regulatory billing guidelines requiredKnowledge of CMS, DHCS, DMHC, NCQA rules and regulations preferredExtensive knowledge of CPT, HCPCS, Revenue, ICD10 coding rules and guidelines preferredExtensive knowledge of general managed care operations required; delegated plan model preferredBasic knowledge of relational database structureAdvanced knowledge of Product System algorithms and processes preferredFamiliar with basic medical product processing preferred More...

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