Senior Systems Configuration Analyst

Job Category:  Information Technology
Department:  Enterprise Configuration (450)
Location: 

Los Angeles HQ, California, US

Position Type:  Full Time
Requisition ID:  483

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

DUTIES

The Senior Systems Configuration Analyst 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 and related surround systems, applications, and databases (e.g., Clinical Care Advance (CCA), PCT, PDM, QNXT Migration Utility, Claims Test Pro, etc.).  The Senior Systems Configuration Analyst collaborates closely with peers and management within the department as well as throughout the organization to ensure that the most complex benefit dictionaries, evidence of coverage tables, provider contractual obligations (including capitation and fee-for-service contracts), Division of Financial Responsibility (DoFR), etc. are monitored, analyzed, updated, etc. and that well thought-out recommendations for improvement are presented and implemented, as warranted.

QUALIFICATIONS & REQUIREMENTS

EDUCATION
Required:
High School Diploma

Preferred:
Master's Degree

EXPERIENCE
Required:
With High School Diploma: 10+ years of experience in a Systems Configuration, Claims or other Operations department with the demonstrated experience on the following list of knowledge/experience below in a healthcare organization  

With Associate's Degree: At least 7 years of experience in a Systems Configuration, Claims or other Operations department with the demonstrated experience on the following list of knowledge/experience below in a healthcare organization  

With Bachelor's Degree: 5-7 years of experience  in a Systems Configuration, Claims or other Operations department with the demonstrated experience on the following list of knowledge/experience below in a healthcare organization

Advanced knowledge of and experience with Medicare and Medicaid rules and regulations and related core and surround systems code and data sets, etc. 
Advanced knowledge of and experience with interpreting and analyzing complex pricing mechanism and contractual terms with providers, delegated groups and related contractual scenarios
Advanced understanding of the application of the Division of Financial Responsibility (DoFR) to claims processing
The successful candidate must be knowledgeable of current Medicare and Medicaid rules and regulations and core and surround systems code and data sets, etc.; possess strong analytical, organizational, and time-management skills; be able to meet strict, tight deadlines with a high level of accuracy; and be able to prioritize multiple tasks.
  
Preferred:  
At least 7 years experience working with a California Medi-Cal managed care plan or Commercial health plan, medical group, or management services organization

L.A. Care offer a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program


Job Segment: Medical, Claims, Medicare, Medicaid, Healthcare, Insurance