Job Description

ROLE SUMMARY:

AllyAlign Health (www.allyalign.com) is a rapidly growing organization focused on revolutionizing the long-term healthcare ecosystem for the benefit of our members, provider and payer partners. Our unique approach to managing care delivery and proactively partnering with healthcare providers has enabled us to achieve industry leading health outcomes for our members.AllyAlign Health has partnered with several Nursing Home companies to form Institutional Special Needs Plans (I-SNPS), which are a form of Medicare Advantage Plans.

In this model, AllyAlign is responsible for administering the health plans, providing shared services such as member enrollment, call center, claims processing, authorization processing, financial services, compliance services and grievance and appeals administration. AllyAlign has grown very aggressively and is working to expand our operational capacity and capability.

Under general supervision by the Director, Claims Configuration and Quality, 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 of AllyAlign Health (AAH) and its various business partners.

The desirable candidate 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.

RESPONSIBILITIES:

• Configure provider contracts and fee schedules in the Citra's 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.

KNOWLEDGE & SKILLS REQUIRED:

• 5+ years of Healthcare Business Analysis experience with the following:Excellent communication with experience working across multiple teams (dev, testing, business etc.)
• Benefit, claims configuration, and pricing configuration
• Experience working with multiple claims systems (Ezcap highly )
• Familiarity with Provider contracts and fee schedules
• Strong SQL Queries and strong Excel (Pivot tables, V-Lookups, Formulas)
• Knowledge and understanding of CMS-1500 and UB-04 Medical Claim Forms
• 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 and process-oriented
• Must be able to perform in a high- volume/time-sensitive production environment
• Must be PC proficient