Centers Plan for Healthy Living

QNXT Configuration Analyst

US-NY-Staten Island
3 months ago
ID
2017-1221
# of Openings
1
Category
Claims

Overview

 

 

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JOB SUMMARY:

 

Centers Plan for Healthy Living is seeking a Configuration Analyst. This individual will serve as the primary resource to our Claims, Provider Services and Authorizations departments. The role will aid in configuration design, analysis, testing, and documentation related to the QNXT software platform regarding, but not limited to, benefits, sponsors, contracts, and authorizations. The Configuration Analyst will coordinate various aspects of planning, development, implementation, communication and evaluation of existing or new functionality related to QNXT

Responsibilities

PRIMARY RESPONSIBILITIES: 

  • Collaborate with other staff/departments to formulate and define system scope and objectives based on user defined needs.
  • Performs root cause analysis on issues and supports resolution.
  • Ensures the proper supporting documentation exists and is maintained for all configuration activities.
  • Can effectively meet deadlines for assigned tasks
  • Tests claims to make sure claims are being processed correctly as per the contract terms.
  • Functions as subject matter expert for industry and system related issues primarily as it related to provider contracts and configuration.
  • Create and maintain all appropriate logs for custom fee schedules and capitation agreements.
  • Coordinates configuration activities with other staff (e.g. business analysts, development team.) and provides feedback to leadership regarding any problems, process issues, policies or procedures which may be of concern or need to be addressed within the configuration system.

Qualifications

Education and Experience:

Education:

Required: Associates degree in medical, business or related field

Preferred: Bachelors/ Masters degree preferred

 

Type of Experience:                                         

Required

  • 2+ years of claims system configuration experience.
  • Understanding of Medicare and Medicaid fee schedules and the ability to interpret/implement contracts using these code set
  • Knowledge of institutional/provider billing practices, Claims Processing and related coding procedures
  • Self-starter, with ability to work independently to complete work and projects.
  • Well-developed problem solving and analytical skills.

 

Preferred:

  • At least three years of diverse work experience in health insurance delivery, claims processing, provider contracts or benefits administration within an organization that administers Medicare, Medicaid or Managed Long Term Care products.
  • 2+ years of experience using the QNXT platform version 4.7 or greater.

 

Specific Technical Skills:

Required:

  • Use of Microsoft Access or similar query tool.
  • Proficiency with MS Office Suite

Preferred

  • Knowledge of SQL, data structures or a programming language

Certifications/Licensure:

Required:    n/a           

 

 

Knowledge and Skills:

  • Effective presentation skills and interpersonal communication skills.
  • Must be able to participate in meetings with all levels of management within the organization
  • Detail oriented, excellent follow up
  • Ability to handle multiple competing priorities in a fast-paced environment.
  • Must be service oriented, quick learner, team player.
  • Appreciation of cultural diversity and sensitivity toward target population

 

SCOPE INFORMATIO

# Direct Reports:      n/a               

 

PHYSICAL REQUIREMENTS:

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Must be able to travel within the five boroughs, Rockland, Erie and Niaga.

The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification.  They should not be construed as an exhaustive list of all responsibilities, duties and skills required.

 

 

 

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