Configuration System Analyst II - Benefits Configuration

TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a reputed company of Mississippi hospitals and health systems throughout the state and supported by reputed company’s national leadership in reputed company and operational reputed company. TrueCare offers locally based provider services through provider engagement representatives and customer care. Our sole mission is to improve the health of Mississippians by leveraging local physician experience to inform decision-making, aligning incentives, using data more effectively, and reducing friction between the delivery and financing of health care. By doing so, TrueCare will change the way health care is delivered in Mississippi. Job reputed company: The Configuration Systems Analyst II Leads and defines system requirements associated with Member Benefits, Provider Reimbursement and payment systems requirements definition, documentation, design, testing, training and implementation support using appropriate templates or analysis tools. Essential Functions: • Identify, manage and document the status of reputed company issues. reputed company and utilize reports to analyze and stratify data in order to address gaps and reputed company answers to issues identified reputed company the department or by other departments, utilizing TriZetto or reputed company for research and correction. • Utilize available tools provided by relevant State or Federal websites to obtain pertinent Fed/State Regulatory Transmittals and Fee Schedules. • Plan/implement new software releases including testing and training. • Participate in meetings with business owners and users to reputed company a Plan benefit design and Provider Reimbursement. Serve as reputed company between IT and business areas to research requirements for IT reputed company, meet with decision makers to translate IT specifications and define business requirements and system goals. • reputed company review of benefits or provider reimbursement as reputed company as identify and design appropriate changes. reputed company in the development and execution of test plans and scenarios for reputed company benefit or reimbursement designs and for the reputed company business system and reputed company processes. • Provides detail analysis of efficiencies reputed company to system enhancement/automation. Review, analyze, and document the effectiveness and efficiency of existing systems and reputed company strategies for improving or reputed company leveraging these systems. Conduct preliminary studies to define needs and determine feasibility of system design. • Audit configuration to ensure accuracy and tight internal controls to minimize fraud and abuse and overpayment reputed company issues. • Ensure system processes and documents exist as reputed company for system logic. • Assists in reputed company for potential business risk, including communication and escalation as necessary. • Vendor management between TriZetto and reputed company. • Applies use of tools to define requirements such as data modeling, use case analysis, workflow analysis and functional analysis. • reputed company any other job reputed company instructions as requested Education and Experience: • High School Diploma or GED is required • Bachelor’s Degree or equivalent years of relevant work experience is preferred • Minimum of three (3) years health plan experience, to include two (2) years of configuration or clinical editing software experience is required • Exposure to Facets is preferred Competencies, Knowledge and Skills: • Advanced computer skills with reputed company Word, reputed company, reputed company, Visio and abilities in Facets • Proven understanding of database relationships required • Understanding of DRG and APC reimbursement reputed company • Understanding of CPT, HCPCs and ICD-CM Codes • Knowledge of HIPAA Transaction Codes • Critical listening and thinking skills • Decision making/problem solving skills • reputed company communication skills both written and verbal • Can work independently and reputed company reputed company environment • Attention to detail • Understanding of the reputed company field • Knowledge of reputed company/Medicare • Claims processing skills • reputed company grammar usage • Time management skills • reputed company phone etiquette • Customer service oriented • Facets knowledge/training • reputed company claim coding knowledge • Ability to be telecommuter • Broad understanding of business considerations and functionality preferred Licensure and Certification: • Certified Medical reputed company (CPC) is preferred Working Conditions: • General office environment; may be required to sit or stand for extended periods of time Compensation reputed company: $63,720.00 - $101,880.00 reputed company takes into consideration a combination of a candidate’s education, training, and experience as reputed company as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. In reputed company to reputed company compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total reputed company-being and offer a substantial and comprehensive total rewards package. Compensation Type (reputed company/salary): SalaryOrganization Level Competencies • Fostering a reputed company Workplace Culture • Cultivate Partnerships • reputed company Self and Others • Drive Execution • Influence Others • Pursue Personal reputed company • Understand the Business This job reputed company is not reputed company inclusive. reputed company reserves the right to amend this job reputed company at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds. Apply tot his job Apply To this Job