Experienced Configuration Business Analyst

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As a Experienced Configuration Business Analyst at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. We are looking for hands on configuration experience.  In this role you will design, build, and validate the Medicaid Information Technology System (MITS) across functional areas. You will support complex system configuration changes and new configuration requirements, including configuration analysis, design, build and testing. Duties include troubleshooting and fixing system configuration errors, performing investigations and root cause analysis of trouble tickets, and ensuring day to day issues are identified and appropriately addressed. Here are the details on this position.

Your role in our mission

In this role you will support complex system configuration changes and new configuration requirements, including configuration analysis, design, build and testing. Duties include troubleshooting and fixing system configuration errors, performing investigations and root cause analysis of trouble tickets, and ensuring day to day issues are identified and appropriately addressed.  

• Configuration Design
• Analyzes provider contracts / pricing, designs / configures provider agreements, configuration validation, configuration peer review
• Communicate design to all stakeholders and varying levels of the organization
• Present and evaluate design solutions objectively and facilitate conflict resolution
• Define, use, and communicate design patterns and best practices in service-oriented analysis, design, and development
• Configuration Build & Maintenance
• Configuration of new and revised claims adjudication logic within a healthcare claims system
• Configuration of products / benefits, providers agreements, fee schedules, and claims payment rules
• Configuration of Claim Adjustment Reason Codes and Remittance Advice Code
• Provider (Contract and Pricing) Configuration
• Configuration Quality Assurance
• Quality assurance and testing within health plan configuration system (e.g., Facets) to ensure configuration is ready for implementation
• Collaborate with quality assurance team to ensure testing efforts align with system deliveries and business processes
• Develop strategies to improve service development life cycle and governance processes
• Develop and use enterprise service and data models Quality assurance and testing
• Provider Pricing Analysis knowledge
• Utilize your ability to manage multiple assignments while maintaining quality standards and meeting assigned deadlines

What we're looking for

• 6+ years configuration experience working in claims configuration
• 6+ years of experience identifying patterns within quantitative data, drawing conclusions, and recommending solutions and approaches, skilled with end-to-end issue resolution
• 6+ years of experience in health care with emphasis in coding, financial rate set up or claims processing in a managed care environment.
• Must be knowledgeable of medical claims data, formats and restrictions including but not limited to Revenue Codes, Place of Service codes, ICD-10 codes, CPT Codes, and Modifiers.xperi
• Experience with QNXT, SQL, PL/SQL is a must
• Experience in Medicaid or Medicare environments.
• Advanced or greater level of proficiency with Microsoft Excel and Word

Preferred Qualifications

• Bachelor’s Degree in Business Administration or related area preferred
• 2+ years’ experience writing and executing SQL/SQL Scripts
• Worked with 3M Grouper is a plus
• Worked with ClaimsXten is a plus

Key Skill List:

• Experience in writing requirements for stored procedures
  • SQL
  • PL/SQL
  • Testing stored procedures
• Hands on Configuration experience of Medicaid systems:
  • Provider Contracts
  • Benefits
  • Rates -