Under the direction of the Manager of HealthRules Payor (HRP) Configuration, the Configuration and Data Analytics Lead will primarily provide critical analytical and consultative support in one or more functional areas of expertise to achieve the successful implementation of a core claims administration platform. Configuration detail design documentation created by this role will serve as a guide for other internal and consulting resources on the team to achieve desired results. In addition, the Configuration and Data Analytics Lead will define and capture data and analytics that will be shared with key stakeholders to ensure that HRP is configured in the most efficient and effective manner to continually meet business needs. This resource will document business requirements and perform proof of concept configuration to demonstrate how the requirements will be met before it is promoted to the final production environment.
location: WATERTOWN, Massachusetts
job type: Contract
work hours: 8am to 4pm
responsibilities: KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS* (in order of importance) % of TIME (Optional)
Collaborate with stakeholders and the Configuration Team as necessary to elicit and document clear business requirements needed for configuration in Health Rules Payor 25% As part of an agile approach, build out and test various system configuration items including Benefits, Provider Contracts, Claims, and other miscellaneous provisions that support Providers, Members, Accounts, Finance, Brokers, and Reporting 20% Lead the continuous analysis and development of key data metrics that will be shared with business stakeholders for making effective decisions on the optimal use of Health Rules Payor to support business functions 20% Provide support for activities related to training , communication, and transition of resources that will manage the configuration and audit functions of the system 10% Create detailed configuration design documentation that will be used by other configuration analysts to build out business rules in the system to meet business requirements 5% Collaborate with cross functional areas to understand configuration and data inter-dependencies 5% Triage possible issues identified and implement applicable remediation and testing to address confirmed configuration issues 5% Provide analysis and support as needed for integration points with HealthRules Payor needed for the successful end- to-end design 5% Provide support and input needed to support functional, system integration , and user acceptance testing 5% JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES EDUCATION:
(Minimum education & certifications required) Bachelor's degree required, certification in medical coding is a plus. EXPERIENCE:
5-7 years minimum experience in Health Insurance or delivery with a working knowledge in one or more operational areas including Claims, Provider Credentialing and Reimbursement, Product Design, HIPPA transactions, Premium Billing, Enrollment, or Medical Code sets. Experience in a data management and/or analytic environment is required with the ability to gather, document, test and implement business requirements. SKILL REQUIREMENTS: T
he successful candidate must be able to work cooperatively as a team member, possess a strong ability to analyze complex business problems and develop technical solutions, adapt to change, clearly communicate, and lead others. · Knowledge and experience in one or more functional areas managed through Health Rules Payor · Must have the analytical skills necessary to understand current data structure, operational processes, and data structure to identify opportunities for improvement, as well as be able to suggest ways to bridge the gap · Problem solving based on understanding of system capabilities and business need · Broad system functional knowledge to be able to conduct an impact analysis · Business process knowledge · Requirement elicitation · Effective writing skills for requirements and test cases · Resource management skills · Able to work collaboratively across teams · Must possess strong communication skills · Ability to understand data structures and synthesize large data sets to identify relevant patterns and trends. · Experience working with various reporting and analytic tools · Provide analytical output to support operational decision-making Candidates must have HealthRules Payor application experience
- Experience level: Experienced
- Minimum 7 years of experience
- Education: Bachelors
- HealthRules Payor Application
- data management / analytics
- healthcare insurance
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.