Analyst II - Product System Configuration - Inland Empire Health Plan

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the direction of the Supervisor of Product System Configuration, the Analyst II – Product System Configuration is responsible for managing the more complex system configurations within the Business System. The primary functions of this position include but are not limited to, accurate interpretation of state, federal, and contractual guidelines related to benefits, fee schedules, contracts, division of financial responsibility (DOFR), codification of services, and business requirements and translating them into configurable parameters within the Business Systems. The Analyst II – Product System Configuration is independent and acts as a subject matter expert for the business areas by helping to drive decisions related to system configuration. The incumbent will develop and maintain comprehensive documentation of business and technical specification requirements utilizing best practice configuration guidelines developed by the Application Architects within the unit. The Analyst II – Product System Configuration will facilitate communication and formally report findings to various department heads and staff in a manner that is appropriate to the skill level and technical expertise of the audience. This position will be required to train and help educate other team members within the unit as necessary.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

• CalPERS retirement
• 457(b) option with a contribution match
• Generous paid time off- vacation, holidays, sick
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Paid life insurance for employees with additional options
• Short-term, and long-term disability options
• Pet care insurance
• Flexible Spending Account – Health Care/Childcare
• Wellness programs that promote a healthy work-life balance
• Career advancement opportunities and professional development
• Competitive salary with annual merit increase
• Team bonus opportunities

Education & Experience

• Four (4) years of experience with the development and remediation of moderately complex system configurations, including capitated provider agreement configurations
• Bachelor’s degree from an accredited institution required
• In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position
• two (2) years of general healthcare experience plus two (2) years of configuration experience is required

Key Qualifications

• Knowledge of Medicare and Medi-Cal fee schedules and benefit structure, and regulatory billing guidelines required
• Knowledge of CMS, DHCS, DMHC, NCQA rules and regulations preferred
• Extensive knowledge of CPT, HCPCS, Revenue, ICD10 coding rules and guidelines preferred
• Extensive knowledge of general managed care operations required; delegated plan model preferred
• Basic knowledge of relational database structure
• Advanced knowledge of Product System algorithms and processes preferred
• Familiar with basic medical product processing preferred