IS System Configuration Analyst II

Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

This position is responsible for providing system configuration for the organization's managed care payment system (QNXT) and other core vendor developed systems at an intermediate level. Ensures system configuration consistency across all core applications, including technical scoping, configuration, testing, and implementation. Participates in the vendor management discipline, supporting long term vendor performance and strategy. Other core responsiblities include IS team and user collaboration, analysis, and documentation.

System Configuration

• Configure and perform daily software maintenance with some management oversight to support the efficient administration and data integrity of multiple systems:
  • QNXT, including claims, utilization management, benefits, contracts, member, call tracking, fees and code modules
  • Optum Claims Edit System
  • TriZetto Enrollment Administration Manager
  • CareOregon Connect provider and member web portal
  • Cactus provider credentialing
  • Claim Test Pro
• Participate in objective decision making to maintain data integrity, alignment and usability of applications for multiple departments across the organization in line with organizational objectives.
• Grow in identifying and articulating how the impact a configuration change has on upstream and downstream services and business workflows.
• Assist IS leadership in IS governance, demonstrating progress learning how to evaluate and monitor applications to ensure they align with and sustain the objectives of the organization.
• Participate in frontend and backend process testing and implementation of new software and software upgrades that supports the organization's strategic goals.
• Perform advanced quality assurance testing to validate configuration behavior against established baselines, in keeping with contract, regulations, and customer requirements.
• Develop and maintain appropriate configuration documentation related to configuration and processes; participate in developing policies and procedures.
• Collaborate with business teams to build accurate system process and training documentation for consistency with system configuration and workflows.

Collaboration

• Collaborate with a variety of stakeholders with guidance from senior System Configuration Analysts or team manager.
• Serve as the point of escalation following the service desk for users experiencing software functionality issues.
• Assist operational departments with system functionality questions for current, new or emerging work.
• Assist users in submitting comprehensive development and Change Control Board requests.
• Assist software developers, production support, engineers and technicians with a variety of user, process and system needs, such as interpreting requirements for technical solutions and verifying deployed solutions meet the business need.
• Support internal and external auditors to provide system configuration information.
• Participate fully and constructively in department meetings, department decisions and department growth.
• Participate as an advance resource in interdepartmental workgroups, such as the Change Control Board, cost and utilization committees, and payment integrity program.
• Maintain impartiality and upholds the objectives of the organization.
• Participate in software user groups, attend conferences to further education and establish relationships with peer organizations.

Research and Design

• Conduct advanced research of software system enhancements and functionality.
• Participate in assessing impact of system changes on the organization and interfacing systems.
• Recommend software configuration that aligns with existing or new business requirements as identified by IS or operations teams.
• Review and interpret provider contracts for accuracy and assess ability to administer.
• Research and interpret CMS, OHA and federal and state regulations with manager guidance.
• Retain knowledge and remain abreast of relevant State and Federal laws and regulations relating to the medical health insurance industry and the Medicare and Medicaid industry.
• Consult with operational departments to determine needs and propose solutions in terms of system design and implementation.
• Research and advise users on best practices of system utilization.
• Identify situations where configuration alone cannot meet business requirements and participate with operational areas to develop supporting processes.

Vendor Coordination and Relations

• Submit detailed, concise system functionality incidents to software vendors using their service software.
• Develop and maintain effective working relationship with vendors to communicate business needs, identify defects, and resolve system functionality gaps.
• Monitor reported issues and escalate serious issues or delays to management.

User Security Administration

• Provision user security access for numerous software applications following policies and procedures of CareOregon, vendor or business partners.
• Understand software usage and user's position responsibilities sufficiently to identify when access is not in keeping with HIPAA minimum necessary protocol.
• Consult with manager regarding new and challenging access requests.
• Conduct regular audits of user security audits.

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 3 years' experience in system configuration or progressively responsible experience in areas that integrate with configurations such as claims processing, coding, auditing, billing, or encounter data

Preferred

• 2 years' experience in claims processing, coding, or auditing
• 1 year experience in health plan system (e.g., QNXT, Facets, Tapestry, etc.) or provider revenue system

Knowledge

• Advanced knowledge in some or all of the following areas:
  • Computer applications skills (claims payment, Excel, Word, Outlook)
  • Computer programming concepts and practices
  • Medicaid and Medicare benefit plans
  • ICD, CPT, HCPCS and other national coding systems
  • Claims operation practices and protocols
  • Principles and practices of managed care systems, procedures, and plan products/systems
  • System plan/benefit building and maintenance
  • HIPAA regulations and compliance
  • Computing/applying rate calculations, and resolving rate calculation disputes

Skills and Abilities

• Effective communication skills, including listening, verbal, written, and customer service
• Ability to clearly articulate policies and instructions
• Ability to exercise professionalism
• Effective ability to network and utilize internal and external resources
• Ability to convey appropriate level of detail to all levels of the organization including non-technical staff
• Growing ability in simplifying and presenting complex concepts in an easily understood way
• Ability to proactively and appropriately communicate status and needs
• Ability to recommend policies, document risks, and propose solutions to information services management and senior leadership
• Possess a high degree of initiative and motivation
• Ability to lead teams of people with some oversight
• Effective project management skills
• Effective vendor management skills
• Ability to produce high quality and timely results, with effective organizational skills
• Effective analytical and research skills; demonstrated progress in seeing patterns in data and drawing appropriate conclusions
• Basic creativity and innovation abilities
• Ability to propose solutions and communicate business value
• Ability to proactively work to build and improve the department, quality, productivity and customer service
• Ability to see beyond the original request and take next appropriate steps
• Effective time management skills to be able to work on multiple projects concurrently
• Ability to maintain a positive attitude
• Ability to understand and adhere to governance and process

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

#LI-Remote

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.