Senior System Configuration Analyst

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Configuration Analyst plays a critical role in ensuring accurate, compliant, and audit-ready system configuration for a Medicare Advantage health plan. This role is responsible for configuring and maintaining the Facets system to support benefit administration, claims processing, provider reimbursement, and division of financial responsibility (DOFR) guidelines,. The analyst ensures all configurations align with CMS regulatory requirements, Sarbanes-Oxley (SOX) compliance standards, and internal policies. The role also supports integration between Facets and other enterprise applications, contributing to a streamlined and compliant operational environment.

Job Duties/Responsibilities:

• Maintain provider contract configuration in Facets, including reimbursement terms, contract types, and servicing arrangements.
• Maintain system coding and benefit related to claim system configuration, including but not limited to provider contracts, division of financial responsibility (DOFR), health plan benefits, authorization rules and workflow to ensure accurate system configuration
• Collaborate with Finance and Provider Operations to ensure DOFR logic accurately reflects contractual obligations.
• Support and maintain system components such as CMU (Configuration Management Utility), Broadcasting, and Workflow to ensure accurate system behavior and operational efficiency.
• Validate configuration changes and perform audits to meet CMS requirements, Medicare Advantage standards, and SOX compliance controls.
• Facilitate integration of Facets with other enterprise applications including data warehouses (e.g., EDW), CRM systems, reporting platforms, and third-party vendors.
• Troubleshoot and resolve configuration-related issues impacting claims processing, provider payment, or benefit delivery.
• Conduct and support user acceptance testing (UAT), regression testing, and production validation for configuration updates.
• Ensure complete and accurate documentation of configuration changes to support internal controls and SOX audit requirements.
• Act as a subject matter expert on Medicare Advantage configuration practices, system integration, and compliance standards.
• Collaborates with cross-functional teams to identify configuration needs and implement effective solutions.
• Collaborates with internal and external auditors to support the audit process related to configuration, including the preparation, organization, and submission of necessary documentation.
• Maintains thorough and concise documentation for tracking of all configuration changes and system testing.
• Recommend process improvements to enhance the efficiency and effectiveness of system configuration.
• Assists in the development and training of process documentations and workflows.

Job Requirements:

Experience:

Required: 3+ years experience with  Facets configuration with CMU, Broadcasting and Workflow.

Education:

Required: Bachelor’s degree in healthcare administration, or a related field (or equivalent experience).

Specialized Skills:

Required:

• Strong understanding of CMS regulatory requirements, Medicare Advantage benefit design, and provider reimbursement.
• Direct experience configuring DOFR logic and provider contracts within Facets.
• Knowledge of SOX compliance requirements, including change management processes and audit documentation.
• Familiarity with system integration and data flow between Facets and enterprise applications.
• Problem Solving Skills: strong analytical and effective problem-solving skills, with the ability to interpret complex healthcare documents and translating them into system requirements
• Excellent communication and interpersonal skills, with the ability to collaborate effectively with cross-functional teams