BPO Supervisor

Job Description

The primary responsibility of the Configuration Analysis Specialist is to provide expert knowledge for the basic functions of the healthcare payer transaction systems, including HealthRules, Facets, or Xcelys, in the successful delivery of benefit plan and contract pricing configuration. You will use experience with Medicare, Medicaid, and Commercial business in documenting requirements to configure the system to accurately automatically adjudicate claims. You will collaborate with operational teams and customers to ensure effective impact assessments of requested configuration changes.  This role requires business system analytical skills, effective communication skills, and knowledge of health plan, federal, and state level coverage policies. 

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Overview of Daily Tasks:

1. Implement the pricing and benefits configuration, maintaining requirements documentation including design documents, business decision logs, meeting minutes, testing scenarios, paper configuration sets, error tracking logs, transition documents and any other tools utilized to configure and maintain the system.
2. Analyze customer requirements, including professional and institutional provider contracts and apply your expertise of payment methodologies, to design configuration for optimal claim auto-adjudication and accuracy.
3. Participate in discussions and business requirements definition with internal and external customers for requests and projects, ensuring the successful delivery of configuration services
4. Provide timely and accurate completion of configuration change requests, maintaining proper documentation and identifying effective control standards of system configuration changes.
5. Create, document and execute test cases based on implemented system configuration and customer’s expected results.
6. Apply your experience in claims processing and claims billing practices to evaluate claims data to design configuration and to problem solve claims processing issues related to possible pricing and reimbursement errors.
7. Mentor less experienced team members including but not limited to configuration and pricing expertise, business rules, and business processes
8. Troubleshoot system and claim processing errors, determining root cause and corrective actions required
9. Participate in project activities across cross-functional teams related to pricing configuration, requirements implementation, defect resolution, and impact reporting
10. Use your domain expertise to proactively identify, recommend, and drive process improvements including automation, enhanced process controls, and process redesign, while considering industry best practices and customer expectations

Knowledge, Skills, & Abilities:

1. 5+ yrs healthcare payer system pricing, contract and benefits configuration experience,  preferably on HealthRules, Xcelys, IkaSystems, Facets
2. 3+ yrs experience in Medicare/Medicaid reimbursement analysis and configuration directly or indirectly with payer organizations with an understanding of Medicare reimbursement methodologies and payment systems.  Experience with Optum EASYGroup a plus.
3. 3+ yrs experience analyzing claims data, specific to claims processing guidelines and HIPAA related codes sets  
4. Demonstrated analytical and problem-solving skills
5. Effective written and verbal communication skills
6. Experience with Microsoft Office products and PL/SQL Developer for querying and analyzing system data

Minimum Educational Requirements:

1. Bachelor’s degree

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