Job Details

Overview

The Configuration Quality Assurance Analyst I is responsible for auditing of Configuration Analyst I and Configuration Specialists on system related job functions. Performs retrospective, concurrent, and special configuration audits. Collaborates with Configuration Technical Development and Quality Assurance teams to identify audit trends and staff training.

Responsibilities

• Collaborate with Lead Auditor and training team to identify audit trends and staff training needs
• Perform monthly retrospective audits of Configuration Analyst I and Configuration Specialist staff
• Perform concurrent audits of Configuration Analyst I and Configuration Specialist staff
• Perform monthly retrospective audits of system configuration
• Provide feedback to Configuration management team on staff performance relating to accuracy of work or system enhancements
• Document audits and report all audit outcomes for Configuration management review
• Write and/or provide 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 AMISYS Advance or other claims payment system, fee schedules, and procedure/diagnosis code tables preferred. Prior training and/or auditing experience desirable. Minimum three (3) years of healthcare experience preferably in a managed care environment; or equivalent combination of education and experience.

Special Skills, Licenses and Certifications

Knowledge of AMISYS Advance or other claims payment system preferred. Knowledge of managed care concepts, policies, and procedures. Ability to understand, interpret, and apply knowledge 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 and 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 within established 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: $77,430.47 - $96,788.08

Disclaimer: 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.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Quality Assurance

Industries

• Insurance

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