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
Partnering with nearly 2 million people on their health journey, Henry Ford Health provides a full continuum of services at 250 care locations throughout southeast and south central Michigan. With 33,000 valued team members, Henry Ford is also among Michigan’s largest and most diverse employers. Our superior care and discoveries are powered by nearly 6,000 physicians, researchers and advanced practice providers. Learn more at 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 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 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 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.