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.
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers.
Benefits
The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health 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.