Core Systems Configuration Analyst III

Job Summary

The Systems Configuration Analyst III Core Systems is responsible for the more complex technical and analytical work related to the maintenance, update, etc. of the configuration of the L.A. Care Health Plan Core Systems applications, and databases (e.g., QNXT Migration Utility, Claims Workflow, Claims Test Pro, NetworX Pricer, etc.). This position serves as a subject matter expert who has the ability to proactively identify and independently rectify issues and opportunities for configuration improvements.   As the subject matter expert, this position performs peer review and applies advanced skillset to ensure quality of the work product.  This position collaborates closely with peers and management within the department as well as throughout and outside of the organization to trouble-shoot and facilitate the maintenance and update of the most complex configuration of the various modules of our core systems, applications, and databases as well as facilitate end-to-end interdepartmental and enterprise projects.  This position also provides well thought-out recommendations for vendor enhancement of the core products. 

Duties

Manage complex benefit dictionaries, evidence of coverage tables, provider contractual obligations (including capitation and fee-for-service contracts), Division of Financial Responsibility (DoFR), etc. and related documentation. Serve as a subject matter expert for configuration change management testing and related best practices. Facilitate production controls and system configuration data codification. 

Monitor and review systems edits, response time issues, etc. and conducting related advanced root cause analysis to identify issues and provide well thought-out recommendations for resolution. Identify and facilitate the implementation/enhancement of systems, process improvements, and best practices. 

Interface and collaborate with peers within and outside of the department and the organization to support configuration management best practices, systems enhancement processes, management of the system configuration life cycle management project/program plans, tracking of configuration change operational issues and resolution.

Perform peer review for all levels of staff and apply advanced skillset to ensure quality of the work product.

Perform other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:
At least 5 years of experience in a Systems Configuration, Claims or other Operations department in a healthcare organization.

Advanced knowledge of and experience with interpreting and analyzing complex pricing mechanism and contractual terms with providers, delegated groups and related contractual scenarios.

Preferred:  
At least 5 years experience working with a California Medi-Cal managed care plan or commercial health plan, medical group, or management services organization.

Skills

Required:
Advanced understanding of managed care operations (including but not limited to, claims processing; provider contracting, network and data management; complex pricing mechanisms; etc.) and the systems that support these operations.

Knowledge of Systems Development Life Cycle (SDLC) procedures in planning the systems configuration.

Advanced understanding of the application of the Division of Financial Responsibility (DoFR) to claims processing.

Advanced knowledge of and experience with current Commercial, Medicare, and Medicaid rules and regulations and core systems code and data sets, etc.

Strong communication, analytical, organizational, and time management skills.

Able to manage projects and initiatives end-to-end. 

Able to meet strict, tight deadlines with a high level of accuracy.

Able to prioritize multiple tasks.

Able to work collaboratively with various level of peers and management throughout the organization.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information