Operations Systems Analyst II - Fee Schedule, Benefits and Contract Configuration

 
Position: Operations Systems Analyst II - Fee Schedule, Benefits and Contract Configuration

Location: US-TX-Bellaire

Talent Area: Information Services

Shift: 8a - 5p

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Summary:

We are searching for an Operations System Analyst II – someone who works well in a fast-paced setting. In this position, you’ll be responsible for the activities related to system updates, new health plan implementation and conversions within the Business Operations teams, oversight of the configuration of contracts, benefits, claim edits, and updates concerning fee schedules, contract rates, and the medical code.

We are looking for candidates that have experience with edit configuration for fee schedules, benefits or contracts.



Responsibilities :

  • Support claims staff with complex claim and payment issues related to system configuration
  • Load and maintain providers, contracts, benefits, and fee schedules in the claims processing system
  • Support external users with application errors related to business applications
  • Identify and develop process improvements outside of the daily scope of work
  • Assist with the development of configuration standards and best practices
  • Maintain thorough and concise documentation for tracking all provider, contract, benefit, or process director changes related to change control request forms/issues
  • Understand the health plan environment and how application software can be used to increase efficiencies, cost-effectiveness, and quality of care
  • Research and resolve claims/encounter issues, pended claims, process director errors, and update the system
  • Provide input on the project implementation plan
  • Monitor pended claims and work queues to update the appropriate systems, escalating issues, testing, making recommendations, and implementing configurations as needed
  • Assist in the planning and coordination of application upgrades and releases
  • Prepare accurate and timely status reports for management
  • Demonstrate the efficiencies of the new system and provide feedback
  • Manage special projects
  • Aid in the design of user procedures, determining specific requirements to increase system effectiveness, and upgrade testing
  • Analyze, interpret, and implement business requirements
  • Coordinate departmental testing with health plan leaders and key stakeholders when necessary
  • Participate in training sessions with users to view new systems and upgrades
  • Identify the impacts and dependencies of new systems/applications


Qualifications:

 

  • High school diploma or GED
  • Bachelor’s degree in computer science, business administration, health care administration, or other related field preferred (can also substitute for 2 years’ experience)
  • 4 years’ experience in health plan payor information systems
  • Knowledge of current business practices and business applications, including those used by the health plan and health plan software environments
  • Experience with process mapping, claims processing, provider contract setup, claim edit system, testing of configuration builds, and the ability to interpret business language into system coding edits is preferred


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