PHP-CONFIGURATION ANALYST
Location
Lansing, MI | United States
Job description
Job Opportunity
Job ID:42791 Positions Location: Lansing, MI Job Description General Purpose of Job:
Description:
Positions Location: Lansing, MI
Job Description
General Purpose of Job :
Responsible for providing configuration and maintenance for production applications. Provides guidance and consultative services in the areas of claims operations, benefit build, system configuration, group builds, and billing builds. Serves as a
resource and liaison between the PHP plans and PHP's outsourcing partner.
Essential Duties :
This job description is intended to cover the minimum essential duties assigned on a regular basis. Associates may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.
- Liaison between PHP and outsourcing partners including participation in routine and ad-hoc meetings.
- System configurations for benefits, claims, network sets, service IDs, supplemental tables, pricing, and agreements.
- Provide operational claims and benefits consultation in an array of PHP initiatives and corresponding meetings.
- Provide knowledge transfer to new PHP employees related to system configuration and processes.
- Understand and configure PHP's systems including Facets and ClaimsXten Select.
- Participate in documentation of Policies and Procedures and Desk Level Procedures that outsourcing partner must follow to correctly process PHP claim reviews and claim adjudication.
- Provide claim, benefit, and system consultation to PHP programmers, IT, and other departments.
- Analyze and map annual diagnosis and quarterly procedure code updates and complete routine file maintenance.
- Work with the appropriate utilization management staff to ensure that service definitions are appropriately updated to reflect coverage and authorization requirement decisions made on new and changed codes.
- Ensure appropriate file maintenance to diagnosis code, procedure code, service ID, and supplemental tables via the outsourcing partner's ticket process.
- Conduct testing in SIT, or other non-prod environment to ensure accuracy of system processing.
- Provide recommendations to modification of service IDs, supplemental tables, and service definitions based on claims issues presented by the health plan or as needed for new products.
- Maintain clinical edit records with the ClaimsXten Select Content Manager based on decisions made by PHP.
- Participate in testing processes for systems' changes and updates.
- Create and maintain the plan product validation grids used to ensure consistent configuration.
- Write queries in SAS Enterprise Guide or other pertinent software to assist in submitting and validating product builds and projects.
- Analysis of monthly Zelis report.
- Liaison with ID Card vendor to add new groups and/or classes as needed
- Verify formatting and product type on ID cards
- Assist IT with resolution of id card issuance problems that arise
Job Requirements
General Requirements
None
Work Experience
* Minimum of five years of experience related to claims processing * Familiarity with health plan benefits, provider arrangements and claims operational requirements
Education
High School diploma or GED Associates degree preferred
Specialized Knowledge and Skills
* Thorough understanding of health plan claims adjudication processes as well as the operational processes involved with the supporting system - Facets. * Creative problem solving with ability to provide clear and understandable recommendations. * Excellent communication and documentation skills. * Demonstrated competence of front end Facets, MS tools
Physicians Health Plan is committed to building and sustaining a diverse workforce that is reflective of the communities that we serve.
Physicians Health Plan is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status
Job Family
Administrative/Clerical
Requirements:
Shift
Days
Degree Type / Education Level
High School / GED
Status
Full-time
Facility
Physicians Health Plan
Experience Level
4-9 Years
Job tags
Salary
