Configuration Analyst IV

The candidate will understand the types of claim, benefit and membership systems data elements that need to be managed in Epic products & other regional benefit applications to support the accurate & timely payment of claims, and maintenance of coverage information. Works under the direction of a Configuration or Validation team Lead or Supervisor within a fast paced and exciting health care environment to support staff in the use of computer software applications including Epic, and related products. Coordinated data input, tracking, and evaluation of Benefit and Plan related installation activities. Escalates system issues to the Lead or Supervisor.

Provides problem solving, and instruction for the use of benefit related software applications. Identifies and triages problems and effectively communicates those problems to the appropriate resources. Ensures communication of the resolution to the customer or consumer. The Configuration/Validation Analyst works with the Product Managers and Developers to define, code, configure and maintain detailed provider/benefit services and provider/benefit plans designs for the applications that require benefit information.

The Configuration/Validation Analyst helps to bring products to market that meet customer (e. g. , member, broker, consultant, employer, etc. ) needs and expectations and ensures that product and operational goals are achieved.

The Configuration/Validation Analyst makes sure benefits are well defined and can be configured in all applications that require benefit and/or provider contract data. The incumbent provides consultation and support to all other employees responsible for configuring benefits into Kaiser Permanente benefit systems. The incumbent also ensures that the benefit coding definitions are consistent across the organization. The incumbent will provide subject matter expertise throughout the organization for benefit coding, billing and benefit configuration and ensure consistency and compliance of benefit coding definitions across applications.

The Configuration/Validation Analyst clearly understands the products and healthcare benefit services offered to our customers, including cost share, limits, accumulators, and regulatory rules and guidelines. We practice honesty, integrity and transparency in all that we do, fostering an environment of collaboration, inclusivity and innovation. Our mission is to leverage people, processes, technology and data to deliver accurate and timely benefits and plans to our business partners, customers and members. Essential Responsibilities: Includes all responsibilities of the 02479 Configuration Analyst III.

Provides technical coding and design advice for benefit development in support of product initiatives. Provides expert knowledge, impact analysis and recommendations related to configuration design and understands impacts of benefit data / provider contract data on all systems that require benefit data / provider contract data and frequently act as a liaison, problem solver and facilitator. Creates daily support status reports. Explains/instructs customers or consumers regarding benefit related issue resolutions.

Operates computer software applications including Epic products. Analyzes benefit configuration documents for feasibility, and regulatory compliance. Ensures correct interpretation and definition of benefits. Analyzes large data sets to identify inconsistencies, and opportunities to improve data organization.

Analyzes claim data to apply correct coverage and troubleshoot issues. Develops and executes processes to analyze, design, configure, code and QA detailed benefit designs, and aids all departments on benefit coding issues. Develops benefit codes and ensures integration with, and across all product lines. Creates and/or manages project plans and timelines to ensure that a given product plan will produce desired results for the targeted market segment and regional operation and/or to meet broader product solutions which would be developed for segment specific strategies.

Reviews, creates and incorporates policies and procedures to implement coding and configuration best practices, and makes recommendations to management on Regional or Program needs to achieve strategic objectives. Conducts systems requirement assessment in support of regulatory changes (e. g. ICD-10, ASC, DRG etc.

). Analyzes benefit evidence of coverage to determine best approach for loading benefits plan offered including co-pays, out-of-pocket maximums and state/regulatory benefits coverage. Develops, documents and executes test plans for configuration testing and validate accuracy of data loaded. Can be hired from any KP region.

Basic Qualifications: Experience Minimum eight (8) years of experience in a related field. Education Associates Degree or two (2) years of related experience. High School Diploma OR GED required. License, Certification, Registration N/A Additional Requirements: Demonstrated ability to research, analyze, design, plan, organize, coordinate, implement, and perform necessary follow-up and closure procedures for system related deliverables.

Understanding of relational databases. Strong experience in documentation, research and reporting. Strong analytical and problem-solving skills. Excellent interpersonal, communication, & listening skills.

Expert level proficiency in Excel. Intermediate proficiency in Access and Query tools. Proven ability to manage complex problems or issues to resolution. Proven ability to collaborate with up- or downstream partners in a positive fashion.

Proven ability to build meaningful relationships with teammates and customer/client partners. Experience interacting with Director level and above. Expert level understanding of Membership, Benefits, and Claims end to end process. Knowledge of state and federal regulations pertaining to health insurance.

Preferred Qualifications: Experience in health insurance or managed care environment preferred. Experience in healthcare systems and analysis preferred. Experience with claims processing systems preferred. Strong critical thinking and analysis skills; verbal and written communications, and interpersonal interactions (e.

g. partnering, conflict management, consulting, etc. ) preferred. Medical and billing coding certification preferred.

Thorough knowledge of benefits, benefit administration and health care delivery from either/both a payor or provider perspective, along with insurance industry practices and systems preferred. Prior experience leading or managing teams is preferred. Understands needs of claims clients and relationships desired. Certification in Tapestry Core and Benefits related Epic modules within a year of employment is highly desired, and subject to management discretion.

COMPANY: KAISER TITLE: Configuration Analyst IV LOCATION: Rockville, Maryland REQNUMBER: 1182701 External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

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