Virginia Premier Health Plan, Inc.

Have you applied with us before?

Claims Systems Analyst II

Claims Systems Analyst II

Job Locations 
US-VA-Glen Allen
Job ID 
2017-3910

Job Description

Overview

The Systems Analyst II position is responsible for developing an extensive expertise in the core claims adjudication system and all interface applications, both customized and packaged.  This position is responsible for coordinating and maintaining assigned Claims Department systems for the program and analyzes business requirements and objectives towards determining the optimal configuration of the requirements.  Responsibilities include but are not limited to the maintenance of the core claims adjudication system; system configuration for provider/hospital contracts, benefit plans, Fee schedule loads; claim analysis, testing, documentation and reporting.

 

In addition, a Systems Analyst II may be the primary contact for one or more claims system interface applications and is expected to provide a high level of expertise with matters relating to this interface and its functionality.  He or she will work with lead configuration analysts to define and prioritize projects.

Responsibilities

  • Configure claims systems to support complex business operations such as benefit plans, authorization requirements, service limits, fee schedules and the development of interfaces
  • Perform complex cost analysis to determine impact of system changes and updates
  • Perform complex data analysis to identify trends
  • Initiate complex claims auto reprocessing efforts
  • Perform root cause analysis to resolve claim payment discrepancies and system or process inefficiencies
  • Facilitate project activity (coordinate follow-up, project planning and serve as subject area expert)
  • Initiate process improvement and automation from concept to implementation
  • Create complex test cases to validate system configuration or updates
  • Identify solutions to data issues/complex data manipulation
  • Create quality and exception reports to audit the integrity of configuration changes and data
  • Create and manage complex business process workflows

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelors Degree in Computer Science, Information Systems, Business or related technical field preferred, OR commensurate experience in lieu of degree

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Proven ability to analyze data and processes, strong analytical skills
  • Ability to retrieve and analyze complex data using Microsoft Excel, Access and SQL
  • Proficient knowledge of software implementation / development life cycle
  • Strong verbal and written communication skills
  • Ability to ensure superior accuracy/quality in deliverables that result in minimal adverse business impact
  • Demonstrated ability to manage multiple timelines and priorities, multi-tasking
  • Managed Care experience; Medicaid or Medicare Insurance
  • Proficient knowledge of flow charting/process mapping preferred
  • Functional knowledge of healthcare claims system/claims configuration preferred
  • Functional understanding of health care claim data sets such as ICD-9/10, CPT and HCPC preferred

WORK BACKGROUND/EXPERIENCE

  • One or more years business experience
  • Claims or Healthcare related experience strongly preferred
  • Claims configuration strongly preferred
  • Two or more years experience of data analysis, system analysis, software installation

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

 

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

 

 

*CB

Need help finding the right job?

We can recommend jobs specifically for you! Click here to get started.