Healthrules Configuration Analyst Jobs Near Me

• Provider Data Management and related downstream processes
• Manages System Configuration functional area purchases and ensures the proper processing of all invoices related to assigned activities.
• Lead the definition, documentation, implementation and continuous improvement of claims adjudication system management policies, standards and processes.
• Supports Claims Audit leadership with the analysis of claims processing metrics to ensure optimal performance.
• Ensures compliance with all regulatory requirements impacting Support Services by collaborating with the Compliance Department and other key functional stakeholders within the organization responsible for execution of policies, standards and processes.
• Establish partnerships and works closely with key operational and clinical staff to ensure claims system configuration accuracy; develop plans to address any potential system inaccuracies or configuration errors.
• Investigate and recommend implementation of tools, techniques and processes with potential to improve management of system configuration.
• Participate in compliance audits and remediate issues identified as required.
• Provide Subject Matter Expertise throughout the implementation of the new claims system, HealthEdge Healthrules Payor (HRP)
• Support Director, Claims Operations and Configuration with daily activities and escalation requests throughout the HRP implementation thus enabling Director to commit more resources to the HRP implementation.
• Support Manager, System Configuration with daily activities and escalation requests throughout the HRP implementation thus enabling Director to commit more resources to the HRP implementation.

• Education:  Bachelor of Science degree in health care, business administration, or related field preferred.  In lieu of a bachelor’s degree an combination of college course work and 7+ years of experience in managed care or a health plan organization demonstrating ascending roles of responsibility will be considered.
• Advanced knowledge of health plan medical benefits, provider reimbursement methodologies, medical, dental and vision terminology, advanced knowledge of claim adjudication and benefit plan application for Medicare Advantage plans.
• Advanced knowledge of CPT, ICD-9, ICD-10 and HCPS coding systems.
• Uses standard office equipment and must be able to operate a motor vehicle and possess a valid driver's license.
• Participates in all project related reporting and communication to the steering committee and other stakeholders.
• Responsible for compliance with Organizational Integrity through raising questions and promptly reporting actual or potential wrongdoing.
• Clearly articulates assignments and direction
• Foster teamwork

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Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.