Imperial Management Administrators Services
Under the general supervision by the Vice President of Operations, the Business Analyst & Configurations Specialist configures and maintains provider contracts, fee schedules and code sets in the EzCap claims adjudication system. Additionally, this position provides technical and administrative support to operational areas to ensure that system configuration and data is precise and ready to support the operational and business needs Imperial Health and its various business partners.
The desirable candidate MUST HAVE EzCap experience and is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position.
Configure provider contracts and fee schedules in the EzCap claims adjudication system.
Maintain and monitor updates of various code sets to ensure accurate and timely operations.
Work with the business for the purpose of analysis and documentation of business needs and requirements.
Analyze, design, test and develop system configuration needs to include documentation, adherence to change management standards and requirements, and preparation of work plans that deliver on schedule and within scope.
Recommend efficient configuration in various systems to include, but not limited to, the main transaction system; medical management system; etc.
Develop, implement, and maintain training solutions using a variety of methods, including one-on-one, web-based and classroom training.
Customize out-of-the-box training content to better support key business processes as needed.
Accountable for in-depth understanding of business/operational workflows and detailed understanding of new workflow objectives and knowledge of how the enterprise software application functionality will support new workflows.
Responsible for assessing training needs of the organization’s staff to ensure successful incorporation of new workflows and policies and procedures into Enterprise software applications training programs.
Provide expertise in healthcare industry best practices.
Work as a team with departmental staff to identify opportunities for operational improvements.
Continually review/audit system operations and operating results to ensure consistent application of policies, practices and optimal system configuration.
Assist in preparing and maintaining up-to-date documentation of system operating policies and practices.
Gather data for analysis to assist in system planning and upgrades.
Maintain and monitor updates of various code sets and contracts to ensure accurate and timely operations.
Ability to extract and synthesize data; and conduct and interpret quantitative and qualitative analyses.
Maintain provider contracts, fee schedules and code sets.
Assist with system upgrades and configurations.
Keep abreast of healthcare industry best practices, system capabilities and managed care regulatory requirements.
Consult with business areas to document business requirements, as is stages and workflows.
Systematic analysis, problem solving, and design of workflows, configuration documents, test scenarios and project status reports.
Data analysis and system audits to support operational efficiencies.
Coordinate and manage training associated with system changes.
Use outstanding customer service principals when servicing the needs of the business users.
Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
Complete special projects and other duties as assigned.
Education / Experience:
5+ years of Healthcare Business Analysis experience with the following: Excellent communication with experience working across multiple teams (dev, testing, business etc.)
At least 3 years of configuration experience using EZ Cap
Experience with increasingly complex configuration setups
Benefit, claims configuration, and pricing configuration experience
Experience working with multiple claims systems (Ezcap experience is highly desirable)
Knowledge & Skills Required:
Familiarity with Provider contracts and fee schedules
Strong SQL Queries and strong Excel (Pivot tables, V-Lookups, Formulas)
Expert level familiarity with Medicare and Medicaid fee schedules
Knowledge and understanding of CMS-1500 and UB-04 Medical Claim Forms
Knowledge and understanding of Medicare Reimbursement / Denial experience preferred
Knowledge of patient billing terminology, collections as well as Medicare and Medicare Advantage billing, rules and regulations and compliance.
Strong understanding of modifiers and Correct Coding Initiative rules.
Familiarity with Medical Terminology
Must be quality, details, and process-oriented
Must be able to perform in a high- volume/time-sensitive production environment
Must be PC proficient
To apply for this job please visit forms.office.com.