Gravie

We partner with brokers across the nation to improve the way people purchase and access healthcare.

Senior Configuration Analyst

AnalystAnalystFull TimeRemoteTeam 51-200H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

2 days ago

Salary

$60.7K - $101.1K / year

Bachelor Degree8 yrs expEnglish

Job Description

• Analyze benefit plan documents to accurately build benefit categories and adjudication rules to accurately and efficiently process claims • Be a leader on the configuration team by supporting training, process development, and peer review / QA. • Support cross-functional teams during implementations/renewals and develop solutions for plan variations. • Provide support to team members for escalations and complex configuration requests. • Perform root causes analysis of adjudication logic and benefit defects. • Support special project implementations as required • Create and update policies and procedures and other documentation of our accumulators and plan configurations. • Perform quality reviews, regression and functional testing in support of configuration changes and application updates. • Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic and outcome oriented.

Job Requirements

  • 3+ years configuring accumulators and benefit plans or other related experience in payer business logic.
  • 5+ years of experience as a claims examiner, coder, or other related experience working with medical claims data.
  • Experience with adjudication processes, analyzing plan designs, and health plan information systems and applications.
  • Knowledge/experience with self-funded, level-funded plan designs.
  • Ability to set priorities, manage time, and work independently.
  • Demonstrated success getting results through collaboration.
  • Extra credit:
  • Familiarity with the mPhasis, Eldorado, Javelina claims processing software.
  • Working knowledge of EDI formats (837/835 claims, 270/271 eligibility) and coding systems (CPT/HCPCS, ICD, DRG).
  • Experience in rapidly-growing start-up business environments.
  • Understand file types A37, 270, 271, 276, 277, 278 experience.

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