job summary: Randstad Technologies is currently seeking a talented Application Architect to join a well-known client of ours within a location in the Denver, CO area. Must be legally authorized to work in the U.S. without sponsorship.
The Application Architect is responsible for analyzing the current data configuration requirements and optimizing and designing improvements in configuration practices and capabilities within enterprise benefit systems.
The Application Architect also supports Analysis, Design, Build and Unit Testing of Benefits & Plans within the Benefit Data Management Group, to ensure accurate and timely benefit set-up for groups and members consistent with the Regional and National architecture strategy. The Application Architect understands the types of benefit administration data elements that need to be configured in the regional benefit systems and applications, including supporting the accurate and timely payment of claims.
location: Lake Oswego, Oregon
job type: Contract
salary: $51.36 - 57.78 per hour
work hours: 8am to 5pm
- Provides technical coding and design advice for benefit development in support of product initiatives
- Provides expert knowledge, impact analysis and recommendations related to configuration design
- Understands impacts of benefit data/provider contract data in all systems
- Creates and/or socializes coding definitions for all benefit designs including tools for project governance, tools and templates, protocols, engagement strategy, escalation protocols, decision-making, risk management and contingency planning
- Develops processes to analyze, design, configure, code and QA detailed benefit designs and provides assistance to all departments on benefit coding issues
- Ensures correct interpretation and definition of benefits
- Develops benefit codes and ensures integration with across all product lines
- Creates and/or manages project plans and timelines to ensure that a given product plan will produce desired results for the targeted market segment
- Identifies and seeks approval for key actions necessary to remediate all problems/issues and makes recommendations to management on steps to ensure product is delivered on time within specifications
- May lead, cross-functional teams of personnel on routine and more complicated scope activities that support Product Development agenda, processes, and programs
- Reviews, creates and incorporates policies and procedures to implement coding best practices and makes recommendations to management on Regional or Program needs to achieve strategic objectives
- Develops and presents recommendations and findings to departmental management and cross-functional leadership
- Develops documentation for senior executives and other key stakeholders and communicate all coding changes
- Collaborates with Benefit Managers to ensure that a comprehensive Project Plan exists for all key benefit initiatives and will coordinate and facilitate all work teams to develop benefit codes
- Maintains detailed knowledge and understanding of the host Claims processing system rules relative to claims payment
- Conducts research and resolution of debarred and sanctioned providers and communicate required system updates to Provider Contracting and Claims Operations.
- A minimum of five years of experience in health care or managed care or equivalent education/experience such as in claims adjudication with knowledge of at least one of the following: membership, benefits, provider contracts and pricing, medical reviews, referral authorizations and code review and fee schedule
- At least three years of experience as configuration analyst
- Significant experience in documentation, research and reporting
- Bachelor's degree in information systems, business or health care administration, or other related field
- High school diploma or GED
- Certification in Tapestry in Core and either AP or Benefits Modules must be obtained within 6 months of hire
- Demonstrated intermediate competency in medical coding, medical terminology, claims processing, logical thinking and understanding of relational database
- Knowledge of state and federal regulations
- Advanced proficiency in MS Office Suite of products
- Thorough understanding of relational databases
- Complete understanding and application of principles, concepts, practices, and standards
- Advanced knowledge in healthcare benefits, benefit administration and health care delivery from either/both a payor or provider perspective, EDI and paper claim lifecycle, along with health insurance industry practices and standards
- Current certification in other Tapestry modules in addition to Core, AP and Benefits
- Basic proficiency in Statistical analysis
- Knowledge of Certification/Accreditation Standards (NCQA, JCAHO, CMS, etc.)
- Knowledge of Internal processes
- Knowledge of Epic Tapestry Modules
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.