Analyst II - Product System Configuration

Inland Empire Health Plan - Los Angeles, CA

Full-time - Mid Level

Los Angeles, CA

Administration of Human Resource Programs

About the position

The Analyst II Product System Configuration at IEHP plays a crucial role in managing complex system configurations within the Business System. This position is under the direction of the Supervisor of Product System Configuration and is responsible for accurately interpreting state, federal, and contractual guidelines related to benefits, fee schedules, contracts, division of financial responsibility (DOFR), codification of services, and business requirements. The Analyst will translate these guidelines into configurable parameters within the Business Systems, acting as a subject matter expert to drive decisions related to system configuration. In this role, the Analyst II will develop and maintain comprehensive documentation of business and technical specification requirements, utilizing best practice configuration guidelines established by the Application Architects. Effective communication is key, as the Analyst will facilitate discussions and formally report findings to various department heads and staff, tailoring the communication style to the audience's skill level and technical expertise. Training and educating team members within the unit will also be a necessary part of the job. The Analyst will assist in developing configuration standards and best practice guides to maintain efficiency, accuracy, and successful integration with internal and external systems. They will analyze business specifications, perform product system error root cause analysis, track incoming requests, and monitor system configuration inventory to ensure compliance with service level agreements and regulatory timelines. Additionally, the Analyst will configure and maintain complex product-related system builds, assist the Contracting team with drafting contract fee schedule language, and develop business requirements for automation of coding updates. Regular audits of check run products will be performed to proactively identify potential system configuration issues before product releases. Overall, this position is integral to ensuring that the system configurations align with the organization's goals and regulatory requirements, contributing to the quality and efficiency of services provided by IEHP.

Responsibilities

• Assist with the development of configuration standards and best practice guides for maintaining efficiency, accuracy, automation and successful integration with internal and external systems and programs.
• Analyze and translate business specifications into detailed technical specifications based on system functionality and develop non-systematic workaround processes when necessary.
• Perform product system error root cause analysis.
• Track incoming requests and issue resolution through Microsoft Access, MediTrac, and Workfront tools.
• Identify and communicate impact of system enhancements or configuration changes on integrated systems and processes.
• Monitor and work daily System Configuration inventory and ensure compliance with established service level agreements and regulatory timelines.
• Configure and maintain complex product related system builds with multi-tiered functionality and interrelated system dependencies, including but not limited to Contracts, Benefits, Fee Schedules, and Service Categories.
• Assist Contracting team with drafting appropriate contract fee schedule language to be in line with system adjudication capabilities and coding standards.
• Develop and maintain business requirements for the automation of coding updates.
• Track, test, and approve new system functionality, enhancements, and bug fixes, including the development and execution of test plans and scripts.
• Perform weekly/bi-weekly audit of check run products to proactively identify potential system configuration issues before products are released.
• Other duties as assigned, including but not limited to Department Projects and LEAN/A3 Events.

Requirements

• Four (4) years of experience with the development and remediation of moderately complex system configurations, including capitated provider agreement configurations.
• Bachelor's degree from an accredited institution required. In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required.
• Two (2) years of general healthcare experience plus two (2) years of configuration experience is required.

Nice-to-haves

• Knowledge of CMS, DHCS, DMHC, NCQA rules and regulations preferred.
• Extensive knowledge of CPT, HCPCS, Revenue, ICD10 coding rules and guidelines preferred.
• Extensive knowledge of general managed care operations required; delegated plan model preferred.
• Basic knowledge of relational database structure.
• Advanced knowledge of Product System algorithms and processes preferred.
• Familiar with basic medical product processing preferred.

Benefits

• CalPERS retirement
• 457(b) option with a contribution match
• Generous paid time off - vacation, holidays, sick
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Paid life insurance for employees with additional options
• Short-term, and long-term disability options
• Pet care insurance
• Flexible Spending Account HealthCare/Childcare
• Wellness programs that promote a healthy work-life balance
• Career advancement opportunities and professional development
• Competitive salary with annual merit increase
• Team bonus opportunities