GENERAL SUMMARY:
This role sits at the intersection of business, IT, and operations—owning system configuration, ensuring compliance, driving quality, and enabling efficient issue resolution and system enhancements.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Initiate the analysis of, and ensure adequate evaluation of, system impacts. Serve as the system expert for customer bases and IT departments.
- Prepare recommendations for enhancements to system applications/vendors.
- Coordinate BCT efforts and customer needs to ensure expeditious response and resolution of system problems/issues.
- Perform ongoing quality review checks to ensure a superior product for on-going production support.
- Responsible for the performance of the application software based on customer requirements and ensuring that systems conform to Government Programs, and Regulatory Agency Standards.
- Assist in the analysis and testing of new Facets releases while identifying the impact to interfaces for externally developed packages.
- Participate in corporate project meetings to disseminate the customer's needs and priorities to corresponding team leadership.
- Interact with other departments and divisions within Health Alliance Plan and Henry Ford Health to establish consistent interpretation of various policies and procedures throughout the system.
- Perform other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor’s degree in computer science or business administration.
- Related and relevant experience may be considered in lieu of academic requirements. Related experience is defined as six (6) years’ experience in Health Care related business and/or claims processing system configuration.
- Two (2) years of claims processing system configuration experience or demonstrated proficiency through relevant Health Alliance Plan specific business experience.
Preferred:
- Five (5) years of Health Care related business experience preferred.
- Knowledge of Facets claims processing with the ability to troubleshoot.
- Ability to work at a fast pace in a constantly changing environment.
- Ability to Interpret Member and Group contracts and translate into Benefit configuration.
- Analytical thinking required for troubleshooting configuration-related defects
- Experience developing Service IDs, Supplemental Mapping, Service Rules, Variable Components, Product Component Configuration in Facets.
- Knowledge of Facets Group, billing, class/plan configuration in Facets
- Experience in open enrollment processes preferred (new Plan/Product creation, passive enrollment, Mass member transfer etc.)
- Knowledge of claim processing, accumulators, provider reimbursement, member eligibility and authorizations
- SQL experience preferred (Oracle and SQL Server)
- Certified Medical Coder preferred
- Demonstrated ability to research, analyze, design, plan, organize, coordinate, implement, and perform necessary follow-up and closure procedures for system related projects.
- Demonstrated ability to collect and prepare data for written/oral presentations.
- Demonstrated ability to communicate effectively.
- Ability to interact with outside sources and maintain professional contacts.
- Excellent written and verbal communication skills are essential.
- Must be able to work effectively with persons of varying position levels and diverse interests.
- Understanding of healthcare industry and managed care concepts.
- Knowledge of a table-driven claims processing system.
- Knowledge of Windows, Microsoft Excel and Word, Query Tools (COGNOS, etc.) and Implementation/Administration of Packaged Claims Processing Applications.
- A high level of human relations skills.
- Ability to adapt to a constantly changing environment.
