Provider Network Operations Data Configuration Specialist II

Job Category:  Information Technology
Department:  Provider Data Management
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  4948

            

Job Summary

The Provider Network Operations Data Configuration Specialist II supports provider data setup, testing, and configuration across L.A. Care's three core systems. This includes management of systems configuration duties related to the core provider data systems, establishing and loading provider and provider group profiles, learning the key provider setup details, and major business and monthly process flows that impact provider data. This position is responsible for supervising the maintenance and at times undertaking provider systems updates directly. The Specialist will also be involved with the development of new configurations and setups and will be expected to provide subject mater expertise to key business and technology teams. The Specialist will support major project development phases such as; testing, pre-deployment, deployment, and in-production fault finding and remediation. The specialist will also work with business process teams and other L.A. Care departments such as; Claims, Membership Accounting, and Finance to ensure that key processes are adequately supported by provider data. Lastly the Specialist will have a training role that will include the need to develop training materials and guides to support training and ongoing knowledge transfer and process standardization.

Duties

Supports the I.T. data configuration related to Core system operations, Core system Conversion, QNXT.

 

Responsible for maintenance of QNXT dictionaries and tables as appropriate and system configuration management documentation for future mission critical systems. 

 

Works with I.T. and business unit service area management and staff to support data configuration management best practices, systems enhancement process, track configuration change operational issues and resolution including Los Angeles DUALS Pilot, CBAS and CCAP.

 

Responsible for implementation duties of any data configuration enhancement or upgrade driving continue integration with related technology solutions.  

 

Responsible for claims data configuration, provider data management, benefit administration configuration and regulated medical code set configuration. 

 

Perform other duties as assigned. 

Education Required
Associate's Degree
In lieu of degree, equivalent education and/or experience may be considered.
Education Preferred
Bachelor's Degree in Health Administration or Related Field
Experience

Required:
At least 4 years of extensive experience within a managed healthcare insurance organization or financial services organization.

Skills

Required:
Significant systems experience in an enterprise system in of the workplaces listed.

 

Experience as subject matter expert, systems super user, or trainer for the enterprise system or knowledge of key underlying I.T. processes such as data transfer and record management.

 

Strong analytical, planning, and organizational skills.

 

Excellent written and verbal communication skills; speaks clearly and persuasively in positive or negative situations.

 

Strong interpersonal and leadership skills, with ability to interact with various I.T. and business client departments/project teams.

 

Ability to work well independently.

 

Previous experience in the planning and implementation of configuration changes to a managed care enterprise-wide information system.

 

Knowledge of standard I.T. programming and logic to facilitate the creation and maintenance of data configuration files and tables, along with supporting documentation. 

 

Strong analytical, planning, and organizational skills.


Preferred:
Systems development and Health Maintenance Organization (HMO) experience, knowledge of managed care health insurance programs with preference given to applicants with strong experience in Medicaid and Medicare benefits administration.

 

Knowledge of Configuration Management (CM) and Systems Development Life Cycle (SDLC) procedures in planning system configuration changes (i.e., use of rigorous documentation, testing / QA protocols prior to deployment of changes into production).

 

Expertise and extensive work experience utilizing Systems Development Life Cycle and related configuration change management methodologies, standards and best practices.

 

Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Additional Information

 

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

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


Nearest Major Market: Los Angeles

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