Edi Data Jobs in Worcester, MA (NOW HIRING)

The Senior Configuration Management Analyst is senior level position responsible for the analysis, design, build, testing, implementation, and maintenance of system configuration to support business requirements and optimize system functionality.  This position is responsible for identifying areas of automation and enhancement to support and improve internal workflows, review system capabilities, and identify gaps and limitations.  In addition, this role is responsible for ensuring adherence to the system development lifecycle and maintenance of all supporting documentation. The role requires strong analytical and problem-solving skills, the ability to work independently and proactively as well as demonstrated skills in providing excellent customer service. Extensive knowledge of all aspects of heath care operations workflow and terminology is also required. 

Duties and Responsibilities

The duties for this position include, but are not limited to the following items:

• Collaborate with business areas to understand financial impact to the organization for approved Medical Cost Action projects
• Triage, research, and resolve escalated issues within industry standard timeframes to meet service level agreements
• Responsible for identifying areas of unused/underutilized system functionality to support business initiatives
• Perform post-implementation audits to ensure configuration aligns with current business requirements and process
• As required, facilitate and lead meetings and selected workgroups
• Mentor and train Configuration Analysts on configuration best practices
• Assist management in in onboarding new hires, acting as onboarding buddy, and leading training sessions
• Assist management with oversight of augmented staff by tracking performance, escalating issues, etcServe as a key resource in facilitating the gathering of business and technical requirements in addition to test cases for all configuration changes
• Work with corporate project stakeholders and Business Analyst to formulate and communicate business requirements and scope of project
• Work with various business areas at different levels within the organization to translate business requirements into technical specifications documents and also act as liaison to translate technical questions and processes into a format the business can understand
• Analyze business requirements and objectives and perform system configuration analysis, design, coding, and unit testing following established processes, standards and procedures
• Develop and maintain a library of standard operational procedures for all configuration tasks, including but not limited to creating and configuring benefit plans using best practice
• Execute the build and implementation of benefit plan adjudication rules
• Perform all configuration changes within multiple test environments, coordinating with testing and project teams to establish timelines and project planning in an effort to maintain the integrity of the environment in use
• Responsible for configuration in depth research, review, and creation of claims data to validate configuration output is performing as expected
• Handle the change control process when configuration results do not match expected outcome, partners with Business Analyst and Testing team to find solutions as needed 
• Develop and execute multiple unit test cases and complete Configuration Control Framework  documentation to support configuration audit  requests
• Act as a liaison between business stakeholders and technical teams to validate and translate unit, positive, negative and regression testing results and any remediation necessary
• Coordinate and document all configuration activity for change control and auditing
• Responsible for coordination of production turnover of all configuration work upon business owner sign off as well as post-production validation
• Responsible for the Configuration Management Promotion process for HealthRules, Optum CES, and Burgess Source and other systems as needed
• Serve as subject matter expert for root cause analysis and issue resolution, by providing guidance on system limitations and functionality
• Develop proof of concepts prototype configuration to support business requirements and develop documented solutions and processes
• Identify gaps between business expectations and system limitations and suggest configuration improvements or streamlined maintenance processes and techniques
• Responsible for completing Peer Quality review of configuration updates
• Coordinate with the Neighborhood Application Support ticket tracking and bringing to resolution any software, configuration, EDI, CES tickets that require updates to the test or production environments
• Perform business analysis duties for designated corporate projects and maintenance requests
• Oversee process development and documentation for any new or altered functionality or business process.   This will also include facilitating an annual audit of actual business processes versus what is documented
• Identify potential areas of automation and aid in re-engineering the underlying business processes
• Recommend and maintain standards for development of business cases and their documentation
• Coordinate multiple simultaneous projects and initiatives, while maintaining business as usual tasks.
• Other duties as assigned

Qualifications

Required:

• Bachelor’s degree or a minimum of nine (9) years of relevant work experience and background equating to the degree in a health care setting
• Minimum of five (5) years of business analysis and system configuration experience (or comparable skill set) working in a healthcare setting
• Demonstrated working knowledge of health care operations including but not limited to authorizations, benefits, enrollment, provider contracting, fiscal operations and claims adjudication

• Demonstrated working knowledge of system development life cycle processes
• Experience in identifying solutions to resolve design issues and to effectively communicate these solutions to the project manager/supervisor as well as stakeholders
• Experience in translating the results of design sessions into configuration requirements
• Experience in user acceptance testing based on business and configuration requirements
• Exceptional ability to identify and track issues and drive them to a conclusion
• Demonstrated ability in leading process improvement initiatives
• Experience producing project artifacts to include status reports, business requirements, non-technical design documents, etc.
• Excellent interpersonal skills, including the ability to work across the organization and to interact, influence and negotiate effectively at all levels of management
• Demonstrated ability to manage multiple priorities simultaneously in a deadline driven environment with accurate resource and time estimates
• Confident team builder and leader with strong motivational skills. Adept in problem solving and resolving conflict
• Proficient in Microsoft Office Suite – Word, Excel, PowerPoint, Visio, Outlook, SharePoint
   

Preferred:

• Bachelor’s Degree in Health Care or Technology
• Experience with Optum CES claim editing software
• Experience with the Health Rules Payor Transactional System
• Working knowledge of State and Federal insurance programs
• Working knowledge of standard billing practices
• Working knowledge of CMS mandates and guidelines
• Certified Professional Coder certification
• Experience with JIRA
• Experience with SQL queries
• Experience with Burgess Source

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.