Reimbursement Configuration Programmer Analyst I/II/III/IV

Job Description:

Summary:

The Reimbursement Configuration Programmer Analyst is responsible for utilizing system development methodologies to analyze, develop, and test system solutions in response to high level business requirements. The Reimbursement Configuration Programmer Analyst is expected to understand requirements, develop work plans, translate the business requirements in order to identify appropriate designs, code to the design specifications, and complete appropriate testing to ensure a quality solution delivery.

Essential Primary Responsibilities/Accountabilities:

All Levels:

Level I: - While undergoing training on all Provider Reimbursement Configuration systems and methods of configuration, maintain responsibility for:

• Reviews and translates high level business requirements in order to analyze, develop and configure and test system solutions
• Codes Small Maintenance of Business projects (Tier 1)
• Communicates with business end-users to ensure timely and appropriate resolution to reported configuration issues and enhancements.
• Learns and understands the end-to-end process of provider pricing configuration to effectively set up reimbursement methodology in the system.
• Develops Microsoft Access Queries in order to research and analyze data used for reimbursement configuration, validation of provider reimbursement configuration and to support research of claims.
• Attend, participate in Vendor educational sessions and workgroup meetings as determined by team
• Identify, collaborate, communicate system efficiencies and improvements with applications used daily.
• Attend, participate in annual vendor enhancement opportunity discussions
• Lead discussion and meeting with vendor SME's for issue and problem solving opportunities.
• Communicate and share updates gathered from vendor discussions with team members.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Level II (in addition to Level I essential responsibilities/accountabilities):

• Responsible for coding the system and the maintenance of reimbursement configuration fields, tables, modules and databases required to support processing on the system.
• Configures, analyzes, researches, and resolves system issues within the scope of their individual configuration team.
• Researches and resolves reported issues related to reimbursement configuration.
• Communicates with business end-users to ensure timely and appropriate resolution to reported configuration issues and enhancements.
• Participates in the development of tools to support reimbursement configuration build and maintenance activities.
• Reviews proposed enhancements to systems; participates in the prioritization and request process.
• Responsible for small-to-medium assignments isolated to a line of business.
• Accountable for complete development cycle for minor development activities from requirements analysis through implementation, ensuring all system changes are defect-free prior to implementation.
• Interacts with business area partners on a 1:1 basis
• Focuses on growth in all areas of work that Reimbursement Configuration is responsible for.
• Represents the Reimbursement Configuration team in meetings and small Tier 1 projects.
• Proactively identifies and addresses risks on system before they become systems issues
• Conducts configuration peer reviews

Level III (in addition to Level II essential responsibilities/accountabilities):

• Participates in ongoing systems coding and configuration changes and new configuration requirements. Analyzes configuration options to design the optimal configuration to ensure quality and efficiency.
• Configures, analyzes, researches, and resolves system issues. Responsible for medium sized assignments illustrating the ability to influence at a manager level.
• Accountable for complete development cycle for minor and larger development activities from requirements analysis through implementation, ensuring all system changes are defect-free prior to implementation.
• Assists in development of presentations as a technical or subject matter expert (SME).
• Identifies and documents best practices and makes recommendations for standards improvement.
• Interacts regularly with business area partners at a manager level, presenting recommendations and statuses.
• Proactively identifies system risks and/or issues as they occur and provides recommendations for remediation.
• Researches and resolves reported issues related to systems configuration.
• Serves as a business rules configuration SME for other Configuration analysts.
• Audits configuration changes made by others before migration into production
• Provides business rules configuration input to development projects, including, but not limited to the development of interfaces and extensions.
• Assists in training new hires

Level IV (in addition to Level III essential responsibilities/accountabilities):

• Directs ongoing systems configuration changes and new configuration requirements. Analyzes configuration options to design the optimal configuration to ensure quality and efficiency.
• Researches and resolves reported issues related to systems configuration.
• Develops, coaches and assists Configuration Analysts.
• Serves as a business rules configuration subject matter expert (SME) for other Configuration Analysts.
• Audits coding and configuration changes made by others before migration into production
• Provides business rules configuration input to development projects.
• Reviews proposed enhancements to systems; participates in the prioritization and request process
• Configures, analyzes, researches, and resolves system issues at an expert level
• Conducts root cause analysis for major issues identifying potential solutions to address the issue.
• Responsible for large sized assignments crossing multiple lines of business, and the ability to influence at a senior manager or director level.
• Advises others of technical/business directions, issues and needs and defines and leads training seminars.
• Develops strategies to meet business goals and translates those strategies into specific action plans.
• Interacts regularly with business area partners at the Manager, Director or Vice President level, presenting recommendations and statuses.
• Maintains a minimal level of coding errors
• Considers risk and impacts of development across organization.
• Assigns Maintenance of Business (MOB) work as needed.

Minimum Qualifications:

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels:

Level I:

• Bachelor's degree in Computer Science or other relevant area or one year of configuration experience.
• In-depth knowledge of structured and/or object-oriented programming techniques.
• Expertise in structured analysis and design, functional testing and data gathering techniques.
• Critical thinking and demonstrated ability to drive solutions to completion.
• Demonstrate the ability to identify root causes of business and/or workflow problems and determine innovative sources for solutions and opportunities.
• Must be able to propose business strategies to assist in meeting the process/production improvement goals.
• Expertise in project planning, and system life cycle activities for all Health Plan Systems.
• Expertise in coordination with Project Development teams across the Health Plan.
• Organizational skills including the ability to manage projects and work across multiple locations.
• Must have the ability to include and work together with cross-functional teams, diverse groups or individuals of all levels to achieve a common goal.
• Strong written and oral communication skills.
• Ability to make clear and consistent decisions using information from multiple sources; ability to take initiative and drive towards desired outcome in a timely manner.
• Strong process orientation skills.
• Strong analytical skills
• Strong problem analysis skills
• Some knowledge of system development life cycle activities.
• Some knowledge of system testing techniques.
• Strong work organization skills.
• Strong relationship building and teamwork skills.

Level II (in addition to Level I minimum qualifications):

• Two years of configuration experience
• In-depth knowledge of system development life cycle activities.
• Training facilitation skills.
• Ability to facilitate effective presentations to front line management staff.
• Experience working (with assistance if necessary) on all types of work associated with the Reimbursement Configuration job duties.
• Ability to complete Maintenance of Business assignments without assistance from others

Level III (in addition to Level II minimum qualifications):

• A minimum of three years of configuration experience with a minimum of one year of demonstrated expertise in more then one concentration area as identified by management preferred
• In-depth knowledge of system development life cycle activities.
• Training facilitation skills necessary to train new hires on team.
• Proficiency in all types of standard updates while requiring minimal guidance
• Performs above average analysis necessary for implementing and coding
• Possess a basic understanding of performing analysis utilizing Microsoft Access or company supported software to support the analysis required for effective reimbursement configuration
• Ability to create table loads via IT
• Possess an above-average knowledge of a minimum of 1 area of concentration (i.e. all Reimbursement Configuration NetworX)
• Possess an advance knowledge of how to code pricing in the Facets NetworX system.
• Possess skills and knowledge of IT process

Level IV (in addition to Level III minimum qualifications):

• A minimum of five years of configuration experience with a minimum of two years demonstrated expertise in multiple concentration areas
• Ability to facilitate effective presentations to senior management.
• As needed, serve as strategic representation in vendor meetings guiding configuration roadmaps
• Strong analytical and problem-solving skills with the ability to recognize and streamline processes as needed.
• Works independently on multiple tasks within the project. Demonstrates excellent communication and presentation skills.
• Regarded as a Reimbursement Configuration Subject Matter Expert in more than one concentration area (i.e. Facets NetworX, Rate Manager, Modeler)
• Demonstrates a strong working knowledge of Facets Data Model , tables
• Proficiency in performing complex analysis utilizing Microsoft Access or company supported software in order to support the analysis required for effective reimbursement configuration.
• Demonstrated excellent documentation skills.
• Possess strong working knowledge of Facets tables, duplicate
• Proficiency in all areas of configuration , i.e. NetworX, Capitation
• Serves as backup to Management as required
• Posses a strong knowledge of Reimbursement Methodologies and rules.

Physical Requirements:

• Must have ability to travel
• Use of a computer for extended periods of time.
• Use of an office telephone a must.

The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Level I: Grade E1: Minimum $60,410 - Maximum $84,000

Level II: Grade E2: Minimum $60,410 - Maximum $96,081

Level III: Grade E3: Minimum $60,410 - Maximum $106,929

Level IV: Grade E4: Minimum $65,346 - Maximum $117,622

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: The opportunity for remote work may be possible for all jobs posted by the Univera Healthcare Talent Acquisition team. This decision is made on a case-by-case basis.

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