Health Plan Configuration Analyst

Description

COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

Summary Description

The Health Plan Configuration Analyst is responsible for the identification, creation and implementation of solutions which will result in the efficient, accurate, and quality configuration and maintenance of Zing Health’s claim adjudication platform. The Health Plan Configuration Analyst consults with assigned operational areas to support operations-identified requirements and ensures timely configuration and implementation of selected solutions either by directly configuring the solution or providing specifications and/or instructions for configuration of the solution. The Health Plan Configuration Analyst should have a strong working knowledge of provider contracts and CMS reimbursement methodologies.

Essential Functions

• Lead the development of business requirements, and solution design process when implementing new plans and products
• Maintaining and updating requests for ICD-9, ICD-10 and/or CPT code changes.
• Supports the Zing Operations and TPA Configuration Teams with all aspects of the benefit configuration process
• Assists with auditing, troubleshooting and resolving claim adjudication issues relating to system configuration
• Supports the maintenance of claims based CARC/RARC codes
• Supports the maintenance of our code editing and pricing software solution
• Performs System Testing (including Patches, upgrades and new configuration)
• Configures or other related applications, as assigned
• Accurately and reliably maintains, documents and tests configuration
• Analyzes existing and proposed business requirements prior to implementation.
• Documents system configuration workflows and process documents
• Diagnoses and resolves system configuration problems
• Acts as liaison with operations, (i.e., IT, Claims, Provider Relations and Finance)
• Maintains an up-to-date knowledge of regulatory changes impacting benefit administration (e.g. ICD-10, ASC, DRG, CPT, HCPCS etc.)
• Assists with translating benefits into system configuration parameters
• Ensures compliance with the health plan policies for complete, accurate and consistent benefit plan design, resulting in appropriate benefit administration and data integrity
• Reviews and revises business and plan design requirements for system set-ups and configuration
• Assist in communicating issues and opportunities for improvement regarding the system enhancements
• Assists with creating and maintaining provider, and member reference materials that reflect appropriate benefits for all programs
• Compiles information and prepares reports, as well as analysis of the results of benefit configuration adverse findings, including appropriate recommendations
• Other projects as assigned
  
  

Requirements

Qualifications Requirements and Preferences:

• Bachelor's Degree in Computer Science, or related field
• 5 years of experience in software configuration management, including software product and application reviews and analysis of system requirements
• Experience troubleshooting and resolving software configuration problems
  
  

Typical Skills

• Communication Management
• Configuration Management
• Auditing
• Troubleshooting/Problem Solving
• Microsoft Office Suite including Excel and Project
• Operations
• Detail Oriented