Configuration Quality Assurance Analyst

City/State

Overview

Work Shift

AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Configuration Analyst in Miami and/or Gainesville, Florida. This is a hybrid position, 2 days in office and 3 days remote.

Scope of position:The Configuration Quality Assurance Analyst is directly engaged in all aspects of the Configuration Quality Assurance (QA) lifecycle, including planning, implementation, creating and executing test scripts, auditing, and reporting to assure the delivery of a high-quality product. The Quality Configuration Assurance Analyst supports integration and business process activities that utilize configuration by performing more complex technical and analytical testing, validation, and quality assurance of business requirements, including, but not limited to, performing, managing, and maintaining testing and quality assurance-related documentation and applying related industry best practices. This includes but is not limited to all benefit and provider (ancillary, hospital, and physician) configuration tasks.

Primary responsibilities include executing the overall Configuration QA strategy, executing, and leading configuration test plans, reporting Configuration quality metrics, identifying process improvements, soliciting business input, reviewing quality trends and errors' root causes, and using this collected data to develop and maintain effective, efficient, and innovative integrated departmental processes for all members of the Configuration Department. Collaborate with the Configuration team on process improvement opportunities and business impacts stressing the importance of accuracy and streamlining efficient and timely processing. Collaborate with all the departments within the organization on issue identification, reporting, tracking, and resolution. This position is responsible for providing approval to deliver configuration builds to UAT, Pre-Prod, and Production.

Also, to further develop departmental processes to generate timely and accurate reports that are used to document and trend internal configuration accuracy rates to promote standard best practices. Leads and drives change by embracing and communicating the organization's shared vision; establishes and maintains harmonious working relationships with management, coworkers, and external contacts, and works effectively in a professional team environment.

Essential Job Functions:

• Identify, recommend, prioritize, and implement new Configuration quality features.
• Design, develop, test, and implement Configuration best practices.
• Perform testing, validation, and quality assurance of business requirements in lower environments and Production post-implementation.
• Diagnose and troubleshoot problems with existing Configurations at all levels.
• Identify, analyze, and validate well-thought-out recommendations for end-to-end business process and/or configuration improvements.
• Facilitate user acceptance test planning, test case specifications, test execution, peer reviews defect management, and test status reporting.
• Follow established procedures for Configuration versioning and change management between multiple environments.
• Identify opportunities for process improvements, including the use of automated testing tools to reduce the testing life cycle.
• Apply current industry and regulatory standards for Configuration Quality.
• Prepare and maintain internal Configuration Quality Assurance documentation.
• Coordinate with vendors and trading partners as appropriate during the design and implementation of third-party applications and the installation of new releases, software enhancements, and defect fixes.
• Interface and collaborate with peers within and outside the department and the organization to support configuration quality assurance best practices as well as business process and systems configuration improvements.
• Work with IT to design, develop, and update processes that would provide efficiency and heighten accuracy rates for Configuration.
• Perform Configuration audits and baseline these against industry best practices.
• Monitor and report on Configuration accuracy on an ongoing basis.
• Focus on achieving departmental and organizational objectives.
• Recognize and observe all company and departmental policies and procedures.
• Provide expertise to design, develop, and maintain systems and processes for the prospective timely audit of quality control processes and identification of internal errors with contractual language and configuration of providers, facilities and ancillary contracts, and member benefits.
• Develop and create audit reports and quality findings to assist with monitoring and reporting to management for staffing corrective actions as appropriate and tracking and trending.
• Develop and maintain a system of checks and balances to assure that the underlying data used for quality auditing is consistent, complete, accurate, and provides value across several functional areas of the department.
• Responsible for providing well-thought-out recommendations for end-to-end business process and/or configuration improvements (as applicable, based on timely identification, analysis, and validation of opportunities for improvement)
• Serve as the expert in the design, development, and implementation of departmental-wide testing and audit procedures.
• Apply knowledge of configuration quality assurance best practices.
• Perform cost-benefit analyses of proposed Configuration Quality Assurance and Audit solutions.
• Conduct research into current and emerging Configuration Quality Assurance trends.
• Keep abreast of trends in Configuration Quality Assurance, coding practices, and Health Care.
• Performs additional duties and responsibilities as assigned by management.

Minimum Requirements:

• Bachelor's in business administration, Health Administration, or related field required
• Masters preferred
• Minimum 5 years of experience in a Systems Configuration, Claims, Benefits, or other Operations department
• Minimum 2 years of experience in Quality Assurance in the Healthcare industry
• Understanding of the Standards for the Professional Practice of Internal Auditing
• Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or other related coding certification preferred (if not attained, willing to acquire within the first year of hire)
• An equivalent combination of education and experience may be considered

Preferred Requirements:

• Advanced claims experience with major claims processing system. Prefer experience with HealthRules Payor and/or QNXT
• Strong process/workflow development & execution skills required
• Advanced skill level in Microsoft Office Products (Excel, Word, PowerPoint, Visio), Business Objects, or SQL
• Strong working knowledge of claims adjudication, benefits administration, and provider/institutional contractual interpretation
• In-depth knowledge of codes, e.g., CPT, ICD-9, HCPCS, DRG, and ASC grouping
• Ability to work on multiple projects/jobs, audits, etc. simultaneously with maximum efficiency providing desirable results and meeting deadlines
• Strong analytical/quantitative and critical thinking skills
• Excellent interpersonal, written, and oral skills required w/ an emphasis on attention to detail & quality control
• Strong ability to influence change
• Ability to work with high-level concepts and in ambiguous situations
• Excellent organizational skills
• Project management experience, preferred

Our Benefits:

As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:

• Medical, Dental, and Vision Insurance
• Paid Annual Leave, Sick Leave
• Flexible Spending Accounts
• Retirement funds with matching contribution
• Supplemental insurance policies, including legal, Life Insurance and AD&D among others
• Work Perks program including discounted movie and theme park tickets among other great deals
• Opportunities for further advancement within our organization

Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For information about our employee benefits, please visit: Benefits - Sentara (sentaracareers.com)

Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!

Note: Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability, and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.

Keywords: Talroo-Health Plan, Benefits Configuration, Benefits & Pricing, QNXT, Health Rules Payer

Job Summary

Qualifications:

Skills

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission "to improve health every day," this is a tobacco-free environment.