• Quality & Integrity Analyst II

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5337
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The Quality & Integrity Analyst position is responsible for the Quality Assurance (QA) review of system configuration changes made to VPHP’s claims processing, editing and pricing systems. The Quality & Integrity Analyst plays a key role in identifying, reviewing, and documenting all results related to the QA review of these system changes. In addition, the analyst will perform pre /post payment random and focus audits.

                                                                                                                                                 

    The analyst will develop a working knowledge of the system configuration of business rules that support coverage of services, as well as the system configuration of contracts and fee schedules that support reimbursement. 

    Responsibilities

    • Review system configuration changes documented in VPHP’s change management system
    • Work with claims systems configuration analysts to clarify system configuration changes
    • Perform data analysis to identify and validate system configuration changes made to the core claim system, as well as changes made to the ancillary claims systems (CES and 3M)
    • Document, track and report all QA review results
    • Develop standard and ad-hoc QA reports for management review
    • Develop a thorough understanding of the claims processing, editing and pricing systems, as well as a basic understanding of interfacing systems and processes such as EDI, Trapeze, etc.
    • Identify and document areas of process improvement, including but not limited to, the systems configuration life cycle, the change management process, pre-implementation testing and post-implementation validation
    • Document key business decisions and processes through process workflows

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Bachelors Degree in Computer Science, Information Systems, Business or related technical field.

    SPECIAL KNOWLEDGE AND/OR SKILLS 

    • Proficient knowledge of SQL Server queries to include complex table joins and database functions (average, count, max, min, etc.)
    • Working knowledge of SQL Server Reporting Services (SSRS)
    • Working knowledge of SQL Server Integration Services (SSIS)
    • Proficient knowledge of Microsoft Excel to include the use of functions, formulas, pivot tables and macros
    • Thorough understanding of systems development life cycle and change management processes
    • Proficient knowledge of flow charting/process mapping

    WORK BACKGROUND/EXPERIENCE

    • Two or more years business experience including Claims or Healthcare related field
    • Two or more years’ experience of Claims related system testing and QA validation

    PHYSICAL REQUIREMENTS

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

    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!

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    Need help finding the right job?

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