Kaiser Permanente Configuration Analyst III (1 of 2) in Englewood, Colorado
THIS REPRESENTS TWO (2) OPEN POSITIONS*
The candidate will understand the types of claim, benefit and membership systems data elements that need to be managed in Epic products & other regional benefit applications to support the accurate & timely payment of claims, and maintenance of coverage information. Works under the direction of a Configuration or Validation team Lead or Supervisor within a fast paced and exciting health care environment to support staff in the use of computer software applications including Epic, and related products. Coordinated data input, tracking, and evaluation of Benefit and Plan related installation activities. Escalates system issues to the Lead or Supervisor. Provides problem solving, and instruction for the use of benefit related software applications. Identifies and triages problems and effectively communicates those problems to the appropriate resources. Ensures communication of the resolution to the customer or consumer.
The Configuration/Validation Analyst works with the Product Managers and Developers to define, code, configure and maintain detailed provider/benefit services and provider/benefit plans designs for the applications that require benefit information. The Configuration/Validation Analyst helps to bring products to market that meet customer (e.g., member, broker, consultant, employer, etc.) needs and expectations and ensures that product and operational goals are achieved. The Configuration/Validation Analyst makes sure benefits are well defined and can be configured in all applications that require benefit or provider contract data.
We practice honesty, integrity and transparency in all that we do, fostering an environment of collaboration, inclusivity and innovation. Our mission is to leverage people, processes, technology and data to deliver accurate and timely benefits and plans to our business partners, customers and members.
Creates daily support status reports.
Explains/instructs customers or consumers regarding benefit related issue resolutions.
Operates computer software applications including Epic products.
Analyzes benefit configuration documents for feasibility, and regulatory compliance.
Analyzes large data sets to identify inconsistencies, and opportunities to improve data organization.
Analyzes claim data to apply correct coverage and troubleshoot issues.
Develops and executes processes to analyze, design, configure, code and QA detailed benefit designs, and aids all departments on benefit coding issues.
Develops benefit codes and ensures integration with, and across all product lines.
Conducts systems requirement assessment in support of regulatory changes (e.g. ICD-10, ASC, DRG etc.).
Analyzes benefit evidence of coverage to determine best approach for loading benefits plan offered including co-pays, out-of-pocket maximums and state/regulatory benefits coverage.
- Minimum six (6) years of experience in a related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
Demonstrated ability to research, analyze, design, plan, organize, coordinate, implement, and perform necessary follow-up and closure procedures for system related deliverables.
Understanding of relational databases.
Strong experience in documentation, research and reporting.
Strong analytical and problem-solving skills.
Excellent interpersonal, communication, & listening skills.
Intermediate level proficiency in Excel.
Understands needs of claim, clients, and relationships.
Intermediate level proficiency in Access and Query tools.
Proven ability to manage complex problems or issues to resolution.
Proven ability to collaborate with up- or downstream partners in a positive and productive way.
Strong critical thinking and analysis skills; verbal and written communications, and interpersonal interactions (e.g. partnering, conflict management, consulting, etc.).
Proven ability to build meaningful relationships with teammates and customer/client partners.
Experience interacting with Director level and above.
Strong understanding of Membership, Benefits, and Claims end to end process.
Proficiency in Tapestry Core and Benefit related modules within Epic within a year of employment, subject to management discretion.
Experience in health insurance or managed care environment preferred.
Experience in healthcare systems and analysis preferred.
Experience with claims processing systems preferred.
Knowledge of state and federal regulations pertaining to health insurance preferred.
Interest in developing leadership skills, or proven ability to lead or manage individuals preferred.
Bachelor's degree in business, health care or another applicable field preferred.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
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 and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
TITLE: Configuration Analyst III (1 of 2)
LOCATION: Englewood, Colorado
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.