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Configuration Analyst Lead Englewood, CO



Description

The Lead BusinessAnalyst is responsible for Analysis, Design, Build and Unit Testing of Benefits within the BETS and KPCC Platform, to ensure accurate and timely claims payment consistent with the Regional and National artifacts (e.g. contractual arrangement(s) made with the Providers, Employer Groups, etc). The HPSC Configuration Analyst understands the types of provider contracting arrangements and/or benefits administration data elements that need to be configured for KPCC platform applications to support the accurate and timely payment of claims.Uses Configuration Design templates to create and maintain artifacts (e.g. Build Worksheets to be used as documentation/specifications for 'Certification or National Testing Teams'). Consults appropriate internal partners on issues of interpretation/clarity. Performs other duties as assigned by Management.

This role is primarily based in the Hawaii region, but will work closely with other regional lead configuration analysts to ensure best practice and standardization

This position will be required to gain Benefit Engine and Tapestry Certification within the first 6 months of the position

Essential Responsibilities:
Includes all responsibilities of the Lead Business Analyst and:
Responsible for defining the principles of Configuration Design for the KPCC platform to ensure accurate and timely claims payment consistent with the Regional and National artifacts (e.g. contractual arrangement(s) made with the Providers, Employer Groups, etc).
Creates and maintains National Configuration Design Templates as 'Build Artifacts' to be used by Configuration and Testing teams and provides Configuration Subject Matter Expertise throughout Definition, Analysis, Build, Test and Deployment phases.
Works closely with Claims, Provider Contracting and Benefit Administration teams for interpretation/clarity of Regional and National contracts, benefits sold and approved benefit policies and ensure consistency and compliance to design definitions across applications and informs them of benefits or provider contracts that are not configurable and may require manual processing.
Works with the process analysis teams (e.g. BPOR) to define Configuration related business processes.
Ensures by working in a collaboration with other teams, that claim codes will inform providers and members as to how the claim was adjudicated (e.g. covered, non-covered/denied, apples to deductible, etc.), per National and Regional documented decisions.
Evaluates how all users of the KPCC Platform may be impacted by Provider or Benefit configuration (e.g. Utilization Management and Benefits and Membership Systems) teams and act as a Configuration Design Subject Matter Expert to others within Claims, Contracting, Benefits Administration or Customer Service, as needed.
Understands 'shared platform data' (e.g. Master Files used to support Provider and Benefit configuration, Reason/Hold Codes, Fee Schedules, etc.) and makes recommended changes that are needed to have accurate and full configuration build as well optimal Platform Design while working with KPIT and HealthConnect teams.
Creates configuration design documents (CDD). Complete proof of concept (POC) for designs, including testing and validation in dedicated environment, ensuring CDD, is cross-functional and all inclusive. Presenting design docs to consumers, including Build Teams, test teams, KP-IT, Stakeholders as needed.
Lead areas of configuration designs for one or more areas, including areas outside of Claims, within ClaimsConnect Platform.
Complete POC in sandbox environment.
Complete Cross Functional Analysis, which involves reaching out to additional team members or customers to understand cross-functional needs.
Performs Root Cause Analysis of defects, categorizing and assigning defects to correct areas, possibly re-designing configuration.
Working closely with regional stakeholders to ensure designs meet business requirements.
Travels for team meetings up 10% of the time.
Owns SBAR (Situation, Background, Alternative, Recommendation) process and presents results to Sr. Leaders.


Additional Requirements:
Tapestry Certification in Tapestry Modules as determined by management OR Certification in Benefits Modules within 6 months of hire into the job. Additional time to acquire certification may be permitted at management's discretion.
Both, Certification and Proficiency levels must be achieved within three times of completing Epic testing. If certification/KP proficiency is a requirement of the position, the individual must pass the application test by the third try. If not, consequences include termination or transition to a different role.
Training and testing maybe delivered at Epic or KP Facility
Demonstrated advanced competency in medical coding, medical terminology, claims processing, logical thinking and understanding of relational database is required.
Knowledge of state and federal regulations.
Strong critical thinking and analysis skills; verbal and written communications, and interpersonal interactions (e.g. partnering, conflict management, consulting, etc.).
Advanced proficiency in Microsoft Office Suite of products.
Expert knowledge in Claims and provider contracts in the appropriate Regional Claims system.
Thorough understanding of relational databases.
Significant experience in documentation, research and reporting.
Ability to define design principles, concepts, practices, and standards.
Full knowledge of industry practices.
Thorough knowledge in healthcare benefits, benefit administration and health care delivery from either/both a payor or provider perspective, EDI and paper claim lifecycle, along with health insurance industry practices and standards.
Knowledge of Certification/Accreditation Standards (NCQA, JCAHO, CMS, etc.)

Preferred Qualifications:
Master's degree preferred.
Certification in 3 Tapestry modules.
Medical and billing coding certification.
Certification requires a minimum of 80% exam score with a 100% score on the associated projects.
Knowledge of Kaiser Permanente Internal processes.
Experience in a Clinical Setting.








Qualifications:

Basic Qualifications:
Experience
- Minimum six (6) years of configuration or coding experience OR minimum of six (6) years in healthcare or managed care (such as in claims adjudication) with knowledge of at least one of the following: membership, benefits, provider contracts & pricing, medical reviews, referral authorizations and code review and fee schedules.
Education
- Bachelor's degree in information systems, business, health care administration, related field OR four (4) years ofexperience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A


Additional Requirements:
- Tapestry Certification in Tapestry Modules as determined by management OR Certification in Benefits Modules within 6 months of hire into the job. Additional time to acquire certification may be permitted at management's discretion.
- Both, Certification and Proficiency levels must be achieved within three times of completing Epic testing. If certification/KP proficiency is a requirement of the position, the individual must pass the application test by the third try. If not, consequences include termination or transition to a different role.
- Training and testing maybe delivered at Epic or KP Facility
- Demonstrated advanced competency in medical coding, medical terminology, claims processing, logical thinking and understanding of relational database is required.
- Knowledge of state and federal regulations.
- Strong critical thinking and analysis skills; verbal and written communications, and interpersonal interactions (e.g. partnering, conflict management, consulting, etc.).
- Advanced proficiency in Microsoft Office Suite of products.
- Expert knowledge in Claims and provider contracts in the appropriate Regional Claims system.
- Thorough understanding of relational databases.
- Significant experience in documentation, research and reporting.
- Ability to define design principles, concepts, practices, and standards.
- Full knowledge of industry practices.
- Thorough knowledge in healthcare benefits, benefit administration and health care delivery from either/both a payor or provider perspective, EDI and paper claim lifecycle, along with health insurance industry practices and standards.
- Knowledge of Certification/Accreditation Standards (NCQA, JCAHO, CMS, etc.)

Preferred Qualifications:
- Master's degree preferred.
- Certification in 3 Tapestry modules.

- Medical and billing coding certification.
- Certification requires a minimum of 80% exam score with a 100% score on the associated projects.
- Knowledge of Kaiser Permanente Internal processes.
- Knowledge of Epic Tapestry Modules.

Primary Location: Colorado,Englewood,Englewood MSSA 9800 S. Meridian Blvd.

Scheduled Hours (1-40): 40

Shift: Day

Working Days: Monday thru Friday

Schedule: Full-time

Job Type: Standard

Employee Status: Regular

Employee Group: Salaried, Non-Union, Exempt

Job Level: Team Leader/Supervisor

Job: Insurance / Claims

Public Department Name: BDM


External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

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