21 Jan
Core Systems Configuration Specialist II
Vacancy expired!
- AgreeYa is a global Systems Integrator and is seeking an Core Systems Configuration Specialist II. The Core Systems Configuration Specialist II is responsible for:
- Leads and oversees the configuration of affiliations, contracts, and related updates to system dictionaries and tables in the core systems.
- This position is knowledgeable about the key provider set-up details, process flows, business needs for provider contract and affiliations, and the impact in the end-to-end processing of claims and reporting.
- This position is responsible for the development and implementation of new contract configurations, affiliations, configuration standards, and best practices guides and will collaborate with various stakeholders to help ensure the optimal configuration of the systems and applications, taking into consideration organizational requirements and related standards and best practices for the configuration.
- Responsible for daily system configuration inventories and ensure compliance with established service level agreements and timelines.
- Audit provider records and affiliations for quality and accuracy and provides documented feedback.
- Generate, distribute, and process configuration reports to facilitate contract affiliations to support clams processing.
- Maintain system dictionaries and tables as appropriate.
- Troubleshoot and participate in defect resolutions of moderate and complex issues related to the assigned configuration component (including the related validation and testing).
- Lead related cross-functional process improvement initiatives and activities that support maintaining code sets, etc.
- Lead affiliation projects.
- Perform other duties as assigned.
- At least 4 years of experience in a Systems Configuration, Claims or other Operations department. Claims experience with QNXT or equivalent processing system.
- At least 2 years of experience working with a California Medi-Cal managed care plan or commercial health plan, medical group, or management services organization.
- Knowledge of provider networks and affiliations and the impact to claims processing.
- Intermediate proficiency with Microsoft Excel.
- Strong communication, analytical, organizational, and time-management skills.
- Able to meet strict, tight deadlines with a high level of accuracy.
- Able to prioritize multiple tasks.
- Bachelor's Degree in Business or Healthcare related field
- In lieu of degree, equivalent education and/or experience may be considered.
Vacancy expired!