Configuration Analyst

Position Title:              Configuration Analyst

Department:                 Business IT & Claims Administration

Reports To:                  Business Analyst Manager

Status:                         Full Time, Exempt

Hours:                          Monday – Friday

Supervision:                This position does not supervise any other staff

Date Updated:              January 2023

Summary:                    This position is responsible for core and adjunct system configuration, automation, and documentation for internal and external claims operations at PrimeWest Health.

Reporting Accountability – N/A

Role and Key Responsibilities
Assist the Business Analyst Manager and PrimeWest Health staff in the following as needed:

1. Update claims-related data elements and code dictionaries in core system
2. Develop and document technical requirements for core claims processing system and claims system-related configuration in accordance with Business Requirements Document (BRD)
3. Ensure the timely and accurate loading of applicable data and data elements, including, but not limited to, fee schedule rates and system code set variables (e.g., new/changed procedure and diagnosis codes)
4. Coordinate the entry, testing, validation, and migration of processing rules configuration into the Test and Live processing environments

• Provide business support for all claims and claims-adjunct systems
• Provide end-to-end support for claims and claims-related activities, from submission of claims through the remittance process
• Test and ensure compliance with Health Insurance Portability and Accountability Act (HIPAA)-compliant data interfaces
• Assist with documentation of claims and claims-related system configuration policies and procedures in an online library
• Participate, as needed, in the accurate and timely completion of regulatory reporting and contract requests
• Perform financial and utilization analysis to determine accuracy of processing, or to assess target areas for prioritization of programming
• Participate in the business development, implementation, and maintenance of effective change controls
• Participate in the development of, and/or operate a tool for, change requests
• Develop and implement effective change control procedures that ensure that organizational priorities are being effectively addressed in a timely manner
• Monitor actual performance versus standards to ensure compliance
• Collaborate with Information Systems & Technology (IS&T) department to ensure regulatory and organizational compliance with mandated systems updates
• Participate in systems evaluation, selection, and ongoing performance improvements
• Actively participate in or lead workgroups to improve system functionality and to generate requirements for systemization of processing
• Participate in the business aspects of systems conversions and upgrades, including testing of new or enhanced features
• Work collaboratively with programmers/developers to design, test, and implement surround code where system solutions are not available or are not sufficient to meet business needs
• Participate in the business input and configuration of claims and claims-related systems
• Provide ongoing quality improvement efforts to ensure that opportunities for system efficiencies are explored and developed with technical assistance
• Keep current with regard to new systems features and functionality
• Participate in the evaluation and recommendation of claims processing systems as well as ancillary software to support the claims and related operations
• Provide input with regard to effectiveness and opportunities for improvement to claims and adjunct software

General PrimeWest Health Responsibilities

1. Abide by the PrimeWest Health Code of Conduct Comply with all PrimeWest Health policies and procedures Comply with HIPAA and all other privacy laws Be familiar with building safety procedures and alert maintenance if something requires attention Keep public areas of the department and office neat and clean Conduct other responsibilities and activities as needed and assigned

Professional Competencies

1. Knowledge and comprehensive business understanding of common health care claim data sets and their applicability to the claims process, including paper and electronic claim form equivalents Familiarity with applicable Medicare, Medicaid, and commercial reimbursement methodologies. Familiarity with Minnesota Medical Assistance (Medicaid) reimbursement methodologies preferred, but not required. Ability to efficiently navigate general health care websites Ability to be flexible and prioritize work Must be detail-oriented and self-motivated

Educational Requirements and Required Qualifications

1. At minimum, two years of post-high school education in business or a field of study related to health care and/or claims administration; may substitute experience in health care billing or claims payment administration on a year-for-year basis. Two or more years of health care claims or claims-related experience in a position with a health care claims payer organization or provider billing environment preferred. Experience working with programmers of IT systems support staff. Demonstrated knowledge of, and proficiency in, Word, Excel, Visio, and Outlook. Flexibility and ability to handle multiple tasks. Demonstrated organization skills and attention to detail. Ability to work effectively with a variety of people both within and outside of the organization. Excellent verbal and written communication skills. Ability to adapt to varied situations requiring constructive thinking, analysis, interpretation, and evaluation. Ability to practice judgment and problem solve in a calm, logical, technical, timely, and accurate manner. Ability to sit at a desk or computer station most of the time. Ability to occasionally lift and/or carry such articles as file folders and small boxes up to 20 pounds. Some travel, including overnight travel, may be required.

Appropriate Licensure and Certification Requirements – N/A  

Collaborative Efforts with Other Departments

Administrative Services Care & Population Health Management Corporate Compliance & Auditing Information Systems & Technology Membership & Provider Services Operations Pharmacy Management Quality & Utilization Management  

Supervision – N/A

This position description is not to be construed as an exhaustive statement of essential functions or responsibilities.

Location: Alexandria, Minnesota –This position offers the possibility for remote/hybrid work

PrimeWest Health will accept résumés for this position until filled. No phone inquiries please. Employment to begin as soon as possible.

Qualified candidates should submit their résumé and cover letter to Samantha Klimek at samantha.klimek@primewest.org. Please include “Configuration Analyst” in the subject line.

Or

Attn: Samantha Klimek
PrimeWest Health
3905 Dakota St
Alexandria, MN 56308

PrimeWest Health is an Equal Opportunity Employer Committed to Diversity, Equity, and Inclusion