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Dahl Consulting
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Pricing Senior Configurations Analyst
Posted: 09/03/2024
2024-09-03
2024-10-18
Employment Type:
Contract
Category: Information Technology
Job Number: 27083
Job Description
Do you have advanced critical thinking and problem-solving skills? Dahl Consulting is currently partnering with a leading health insurance company. We work one-on-one with great candidates to help connect them with local employment opportunities. This company is hiring a Pricing Senior Configurations Analyst for a contract position! Interested? Get more details below.
The Pricing Senior Configurations Analyst ensures the integrity of the health plan claims processing function by reviewing, analyzing, and configuring the health plans’ core system platforms. This position obtains and analyzes the internal workflow, setup, and design of the software applications. They will consult with users to identify current operating procedures and to clarify program objectives, create documentation to describe program development, benefit logic, medical coding, work instructions, and corrections.
What you’ll do as the Pricing Senior Configurations Analyst:
As an equal-opportunity employer, Dahl Consulting welcomes candidates of all backgrounds and experiences to apply. If this position sounds like the right opportunity for you, we encourage you to take the next step and connect with us. We look forward to meeting you!
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- Worksite Location: Remote
- Contract Duration: 6-12 months
The Pricing Senior Configurations Analyst ensures the integrity of the health plan claims processing function by reviewing, analyzing, and configuring the health plans’ core system platforms. This position obtains and analyzes the internal workflow, setup, and design of the software applications. They will consult with users to identify current operating procedures and to clarify program objectives, create documentation to describe program development, benefit logic, medical coding, work instructions, and corrections.
What you’ll do as the Pricing Senior Configurations Analyst:
- Run claims through the system in multiple real-life scenarios to ensure consistency in running and reporting claims, and ensure compliance with both State and Federal CMS and Medicare Advantage regulations
- Participate in systems testing, develop procedures and controls, and provide recommendations for the ongoing improvement of the updated process
- Perform unit and end-user testing for a new configuration, programming enhancements, new benefit designs, new provider contracts, and software changes that affect claims adjudication and member/client service functionality
- Identify opportunities and recommend Core Claim System solutions that increase automation, resolve system deficiencies, and enhance claims processing and reporting to meet and exceed business requirements
- Facilitate the setup of fee schedules and rates to set up configuration correctly to ensure providers are paid according to the source of truth(s)
- Audit configurations of benefit plans and fee schedules against contract requirements to verify configuration following source documentation
- Complete regularly scheduled reviews of all code sets (CPT, HCPCS, Revenue, etc.) in collaboration with other areas to ensure compliance with medical policy and benefit configuration
- Perform root-cause analysis on Core Claim System Configuration issues across all productions, document results, and present business impact analysis for proposed claims configuration changes
- High school diploma or GED required; Associates or Bachelor’s degree preferred
- 5+ years’ experience in a similar role of complex system design and medical coding experience is preferred
- Excellent analytical, organizational, and problem-solving skills
- Knowledge of project work with the ability to meet deadlines, understand requirements, and support business deliverables
- Knowledge of benefit/claims configuration for claims and enrollment systems
- Knowledge of audit processes and system controls
- Experience in developing training and communication plans
- Ability to read, write, speak, and apply mathematical concepts and sound reasoning to successfully perform the essential duties and responsibilities of this job
- Must be able to perform basic operations on a personal computer within the Windows operating system
As an equal-opportunity employer, Dahl Consulting welcomes candidates of all backgrounds and experiences to apply. If this position sounds like the right opportunity for you, we encourage you to take the next step and connect with us. We look forward to meeting you!
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