Configuration Quality Assurance Analyst II

Overview

The Configuration Quality Assurance Analyst II is responsible for auditing Configuration staff up to Analyst II functions on system related functions. Performs retrospective, concurrent, and special claims audits on assigned configuration projects. Completes audit documentation and reports. Collaborates with Technical Development and Quality Assurance teams to identifying trends for training purposes. Performs all activities related to auditing, tracking and documenting staff performance of operational processes for the Configuration department. Provides feedback and recommendations to the Configuration leadership team on trends and staff training.

Responsibilities

• In collaboration with Configuration management team, Senior Configuration Analysts, Project Management, Technical Development, and Quality Assurance teams to identify audit trends and staff training needs
• Perform monthly retrospective audits of Configuration staff up to Configuration Analyst II functions
• Perform concurrent audits of Configuration staff up to Configuration Analyst II functions
• Document audits and report all audit outcomes for Configuration management review
• Writes and/or provides input on Configuration department procedures
• Maintain current knowledge of assigned configuration areas of responsibility, and related Partnership Policy and Procedure, Medi-Cal Provider Manual, Title 22 regulations, CMS Medicare regulations, and Knox Keene regulations
• Maintain current knowledge of all Partnership processes that impact Configuration department responsibilities Including but not limited to Claims, Member Services, Finance, Pharmacy, Health Services, Provider Relations, IT-EDI, IT-Amisys. IT-Webteam processes
• Support design and enhancement to Configuration audit process
• Support configuration related testing activities
• Support configuration related project activities
• Other duties as assigned.

Qualifications

Education and Experience

Bachelor’s degree in related field preferred. Experience with claims payment, claims editing and/or authorization management systems, fee schedules, and procedure/diagnosis code tables preferred. Prior trainingand/or auditing experience desirable. Minimum five (5) years of healthcare experience preferably in a managed care environment; or equivalent combination of education and experience.

Special Skills,

Licenses and

Certifications

Knowledge of claims payment, claims editing and/or authorization management systems preferred. Knowledge of managed care concepts, policies, and procedures. Ability to understand, interpret, and applyknowledge of regulatory requirements. Ability to quickly acquire in-depth knowledge of Partnership systems, software, applications, processes, and managed care issues. Working knowledge of MS Windows related applications and experience with database applications, typing, and 10-key use.

Performance

Based

Competencies

Strong written and oral communication skills with ability to interpret and understand technical requirements. Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy. Ability to work on multiple tasks withinestablished time frames and sometimes conflicting priorities. Good organizational skills with ability to maintain accurate records and documentation of actions and decisions.

Work Environment

And Physical

Demands

Ability to use a computer keyboard. More than 60% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 10 lbs.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$85,173.51 - $106,466.89

IMPORTANT DISCLAIMER NOTICE                                                                    

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Salary : $85,174 - $106,467