Business Configuration Analyst - Health Alliance Plan
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor's Degree in Computer Science or Business Administration.
- Related and relevant experience may be considered in lieu of academic requirements. Related experience is defined as six (6) years’ experience in Health Care related business and/or claims processing system configuration
- Two (2) years of claims processing system configuration experience or demonstrated proficiency through relevant HAP specific business experience.
Benefits Configuration
Additional preferred requirements
⦁ Interpret Member and Group contracts for Benefit configuration.
⦁ Experience developing Service IDs, Supplemental Mapping, Service Rules, Variable Components, Product Component Configuration
⦁ Knowledge of Claims Processing on Facets with ability to troubleshoot
Provider Configuration
Additional preferred requirements
⦁ Experience with Facets Provider Structure including Network Sets, NWPR and NPPR functionality
⦁ Knowledge of Claims Processing on Facets with ability to troubleshoot
Pricing Configuration
Additional preferred requirements
⦁ Experience with Facets NetworX Agreement Configuration
⦁ Experience with Medicare PPS Pricing Methodology
⦁ Experience with configuring Optum PPS Modules to work in a Facets environment
⦁ Knowledge of Claims Processing on Facets with ability to troubleshoot
Technical Configuration
Additional preferred requirements
⦁ Knowledge of Facets 5.74 group structure and claims processing fundamentals is required
⦁ Skilled in SQL, PL/SQL Programming under Oracle 11g and Unix Korn Shell scripting
⦁ Knowledge of Cognos
⦁ Knowledge of business principles and functions
⦁ Knowledge of Windows, Microsoft Excel and Word, Client Server Applications, Client Server Data Base Structure, Project Management Tools, Implementation /Administration of Packaged Applications and SQL Developer.
⦁ Knowledge of Facets Configuration Migration Utility (CMU) and Facets Security Management Tool (SMT)
SKILLS AND ABILITIES:
- Demonstrated ability to research, analyze, design, plan, organize, coordinate, implement, and perform necessary follow-up and closure procedures for system related projects.
- Understanding of healthcare industry and managed care concepts.
- Knowledge of a table driven claims processing system.
- Knowledge of Windows, Microsoft Excel and Word, Query Tools (COGNOS, etc.) and Implementation/Administration of Packaged Claims Processing Applications.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. My Choice Rewards is a program as diverse as the people it serves. There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services. Employee's classified as contingent status are not eligible for benefits
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.