Tufts Health Plan
Sr Configuration Analyst For Healthrules Payor Configuration
Under the direction of the Manager of HealthRules Payor (HRP) Configuration, the Sr Configuration Analyst for HRP Configuration will provide deep analytical and consultative support in one or more functional areas of expertise to ensure the optimal configuration and on-going maintenance of HRP, the core claims administration platform for Point32Health. Configuration detail design documentation created by this role will serve as a guide for other internal and consulting resources on the team to achieve maximum system functionality. In addition, the Sr Analyst will play a key role in analyzing the requirements, building the system configuration components, and support the testing of the system. Key Responsibilities/Duties what you will be doing (top five): Using an agile approach, assess requirements, research business and system impacts of requirements, define possible configuration options, configure system and support user testing. Collaborate with stakeholders and the Configuration Team to elicit and document clear business requirements needed for configuration in Health Rules Payor Support integration and business process activities that utilize configuration as part of the end-to-end solution to meet business requirements Provide analysis and documentation that supports configuration management, design, requirements training, traceability, and audits Create detailed configuration design documentation that will be used by other configuration analysts to build out business rules in the system to meet business requirements Qualifications what you need to perform the job Certification and Licensure Certification in medical coding is a plus. Education Required: Bachelor's degree in a related field Preferred: Master's degree Experience Required: 5-7 years of professional experience Preferred: 5-7 years minimum experience in Health Insurance or delivery with a working knowledge in one or more operational areas including Claims processing, Provider Credentialing & Reimbursement, Product & Benefit Design, Enrollment, or Medical Code sets. Experience in system configuration is required with the ability to analyze requirements, assess impacts, and provide design solution to implement business requirements. Experience in a data management and/or analytic environment with the ability to gather, document, test and implement complex business requirements. Skill Requirements Knowledge and experience in one or more functional areas managed through HealthRules Payor Must have the analytical skills necessary to understand current data structure and operational processes to identify opportunities for improvement, as well as be able to suggest ways to address functional the gaps Problem solving based on understanding of system capabilities and business need Broad system functional knowledge to be able to conduct an impact analysis Business process knowledge Requirement elicitation Effective writing skills for documentation of requirements and system design documents Resource management skills Able to work collaboratively across teams Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel): Must be able to work under normal office conditions and work from home as required. Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. May be required to work additional hours beyond standard work schedule. Disclaimer The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time. Compensation & Total Rewards Overview As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law. Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes: Medical, dental and vision coverage Retirement plans Paid time off Employer-paid life and disability insurance with additional buy-up coverage options Tuition program Well-being benefits Full suite of benefits to support career development, individual & family health, and financial health We welcome all All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Scam Alert Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org
Under the direction of the Manager of HealthRules Payor (HRP) Configuration, the Sr Configuration Analyst for HRP Configuration will provide deep analytical and consultative support in one or more functional areas of expertise to ensure the optimal configuration and on-going maintenance of HRP, the core claims administration platform for Point32Health. Configuration detail design documentation created by this role will serve as a guide for other internal and consulting resources on the team to achieve maximum system functionality. In addition, the Sr Analyst will play a key role in analyzing the requirements, building the system configuration components, and support the testing of the system. Key Responsibilities/Duties what you will be doing (top five): Using an agile approach, assess requirements, research business and system impacts of requirements, define possible configuration options, configure system and support user testing. Collaborate with stakeholders and the Configuration Team to elicit and document clear business requirements needed for configuration in Health Rules Payor Support integration and business process activities that utilize configuration as part of the end-to-end solution to meet business requirements Provide analysis and documentation that supports configuration management, design, requirements training, traceability, and audits Create detailed configuration design documentation that will be used by other configuration analysts to build out business rules in the system to meet business requirements Qualifications what you need to perform the job Certification and Licensure Certification in medical coding is a plus. Education Required: Bachelor's degree in a related field Preferred: Master's degree Experience Required: 5-7 years of professional experience Preferred: 5-7 years minimum experience in Health Insurance or delivery with a working knowledge in one or more operational areas including Claims processing, Provider Credentialing & Reimbursement, Product & Benefit Design, Enrollment, or Medical Code sets. Experience in system configuration is required with the ability to analyze requirements, assess impacts, and provide design solution to implement business requirements. Experience in a data management and/or analytic environment with the ability to gather, document, test and implement complex business requirements. Skill Requirements Knowledge and experience in one or more functional areas managed through HealthRules Payor Must have the analytical skills necessary to understand current data structure and operational processes to identify opportunities for improvement, as well as be able to suggest ways to address functional the gaps Problem solving based on understanding of system capabilities and business need Broad system functional knowledge to be able to conduct an impact analysis Business process knowledge Requirement elicitation Effective writing skills for documentation of requirements and system design documents Resource management skills Able to work collaboratively across teams Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel): Must be able to work under normal office conditions and work from home as required. Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. May be required to work additional hours beyond standard work schedule. Disclaimer The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time. Compensation & Total Rewards Overview As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law. Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes: Medical, dental and vision coverage Retirement plans Paid time off Employer-paid life and disability insurance with additional buy-up coverage options Tuition program Well-being benefits Full suite of benefits to support career development, individual & family health, and financial health We welcome all All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Scam Alert Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org