Job Description
Business Configuration Analyst
Specific Duties
• Configures and maintains the business rules within the claims adjudication ecosystem.
• Configures the HealthRules software from development into the testing and production phases.
• Provides application and technical support for the HealthRules software as well as troubleshooting for end users.
• Identifies researches and resolves inaccuracies and inconsistencies in the business rules as they impact claims payment and other upstream and downstream transactions.
• Engages in intake with business clients to evaluate business requirements.
• Recommends and implements benefit setup based on knowledge of system configuration capabilities and information obtained from business clients.
• Independently evaluates business procedures and problems.
• Participates in business requirements gathering sessions to identify specifications and solutions.
• Creates test case scenarios for application and configuration testing and ensures appropriate testing has been completed before the software enters the production phase.
• Identifies and assesses potential problems and performs and implements system enhancements, modifications and upgrades.
• Defines with business client data reporting and trending reports and makes recommendations to management.
• Designs and develops user system documentation.
• Works with IT to define business systems requirements.
• Performs investigation, evaluation and documentation of system design findings.
• Evaluates and monitors coded data elements.
• Assists users in understanding business system functions.
• Additional duties as assigned.
Knowledge Summary
• Must have a thorough understanding of the configuration of business rules that support reimbursement policies and methodologies, member/provider contracts, and claims adjudication and correspondence.
• Must have demonstrated strong analytical, technical and problemsolving skills.
• Ability to work with multiple business systems and have a good understanding of system design.
• Demonstrated experience in Microsoft office products and project management tools.
• Strong communication and analytical skills required to covey complex technical ideas, concepts and applications.
• Must understand the business environment and associated systems.
• Must be detail oriented and understand corporate objectives.
• Must have the ability to follow through on project life cycles.
• Experience in data analysis, testing and implementation.
• Technical writing skills needed.
• Must be able to present findings to management.
• Must be able to create timelines and work with internal and external departments to gather appropriate information.
• Skills in coaching and mentoring.
• Works independently on projects, identifies and implements business systems solutions with minimal supervision.
• Good understanding of available resources to investigate, perform testing, analyze and present initial findings.
• Strong presentation skills required.
• Knowledge of project management tools and business system methodology
• Proficiency in Healthcare and Health Plan terminology, medical coding (e.g., CPT, HCPCS, ICD9, CDT, Revenue, DRG and other relevant medical and industrystandard codes)
Education & Experience
• Bachelor's degree in business administration, Management Information Systems, Computer Science or equivalent work experience.
• In lieu of degree, minimum 34 years proven configuration experience, preferably on Facets, Health Rules, Diamond, Amisys Advance or similar payer system Strong project management skills needed.
• 2+ years HealthCare operations or Healthcare claims processing experience
Hybrid
Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the TriState Area of Delaware, New Jersey, or Pennsylvania.
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.