Position Summary/Position
Under the direction of the Supervisor of Provider Data Configuration, the Analyst is responsible for managing the front-end maintenance of Provider records within the Business System. The primary functions of this position include but are not limited to, accurate interpretation of contractual and claim related provider information, systematic review, and setup of provider data to be in line with business requirements, and in-depth root cause analysis for provider configuration related issues that arise from claims and integrated systems errors. The Analyst is independent and acts as a subject matter expert for the business areas and other team members, by helping to drive decisions related to provider configuration. The incumbent will develop and maintain comprehensive documentation of business and technical specifications based on best practice guidelines and regulatory operational requirements. The Analyst will facilitate communication and formally report findings to various department heads and staff in a manner that is appropriate to the skill level and technical expertise of the audience. This position will be required to train and help educate other team members within the unit as necessary. Major Functions (Duties and Responsibilities)
1. Assist with the development of Provider configuration standards and best practice guides for maintaining efficiency, accuracy, automation and successful integration with internal and external systems and programs.
2. Analyze and translate business specifications into detailed technical specifications based on system functionality, and develop non-systematic workaround processes when necessary.
3. Track incoming requests and issue resolution through Access and Workfront tools.
4. Identify and communicate impact of system enhancements or configuration changes on integrated systems and processes.
5. Monitor and work daily Provider related pended claim inventory and ensure compliance with established service level agreements and regulatory timelines.
6. Configure and maintain Providers, Vendors, Offices, Corporations, Contract Mappings, and Provider/Member LOAs within the Business System.
7. Perform mass member PCP assignment moves.
8. Review Provider setup Quality Control reports and remediate system records as necessary.
9. Perform Provider configuration audits as necessary.
10. Assist IT team with business and technical specification requirements and documents for successful Provider record integration with the Provider Portal, MedHok, and the Provider Network Database.
11. Track, test, and approve new system functionality, enhancements, and bug fixes, including the development and execution of test plans and scripts related to Provider configuration. Major Functions (Duties and Responsibilities) Cont Supervisory Responsibilities Leading: Self Experience Qualifications
Two (2) years of experience in Business Systems Configuration or Managed Care Operations or Contracting in Healthcare experience required. Preferred Experience
Experience in major managed care system migration/implementation preferred. MySQL, SSMS, SSRS experience preferred. Education Qualifications
Bachelor’s Degree in Business Administration, Health Care Administration, Computer Information Systems (CIS), Management Information Systems (MIS), or other related field from an accredited institution required.
In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position: two (2) years of Health Care or Managed Care Operations experience is required and two (2) years of claims auditing or Provider Contracting required. This experience is in addition to the minimum years listed in the Experience Requirements above. Preferred Education Professional Certification Professional Licenses Drivers License Required No Knowledge Requirement
Knowledge of Medicare and Medi-Cal fee schedules and benefit structure, and regulatory billing guidelines preferred. Knowledge of CMS, DHCS, DMHC, NCQA rules and regulations preferred. Extensive knowledge of CPT, HCPCS, Revenue, ICD10 coding rules and guidelines a plus. Familiar with basic medical claims processing. Experience in major managed care system migration/implementation preferred. Basic knowledge of general managed care operations required; delegated plan model preferred. Basic knowledge of relational database structure. Skills Requirement
Microcomputer skills, proficiency in Windows applications preferred. Intermediate knowledge of Microsoft Access application. Excellent communication and interpersonal skills. Strong organizational skills. Skilled in the use of Microsoft Excel. Exceptional problem solving and critical thinking skills. Strong presentation and written communication skills. Abilities Requirement
Professional demeanor. Ability to work independently and solve complex problems with little to no assistance. Ability to effectively manage multiple competing priorities and adhere to strict timelines. Commitment to Team Culture
The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Working Conditions
Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership. Work Model Location Telecommute Physical Requirements Keyboarding: Traditional - FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Keyboarding: 10-Key - FREQUENTLY Hearing: One-on-One - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Near Visual Acuity - FREQUENTLY Sitting - FREQUENTLY Indoors - FREQUENTLY Lighting - FREQUENTLY Regular contacts: co-workers, supervisor - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY
A reasonable salary expectation is between $70,012.80 and $89,273.60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.