Job Description
Hi, weâre Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.
A Little More About this Role:
Weâre looking for a Senior Configuration Analyst to join our configuration team. As Gravie looks to continue its Member-centric approach to healthcare, we need an Analyst to create and maintain the benefit categories, health plans, and adjudication logic that power our health plans, develop solutions to automate key claims processing workflows, and troubleshoot observed defects in the output of the overall claims configuration process. Qualified applicants should have an understanding of benefit plans, the coding systems used to document medical services, and the way these codes are organized into benefit categories and used in claim processing logic.
You will:
- Analyze benefit plan documents to accurately build benefit categories and adjudication rules to accurately and efficiently process claims
- Be a leader on the configuration team by supporting training, process development, and peer review / QA.
- Support cross-functional teams during implementations/renewals and develop solutions for plan variations.
- Provide support to team members for escalations and complex configuration requests.
-Perform root causes analysis of adjudication logic and benefit defects.
-Support special project implementations as required
-Create and update policies and procedures and other documentation of our accumulators and plan configurations.
-Perform quality reviews, regression and functional testing in support of configuration changes and application updates.
-Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic and outcome oriented.
You bring:
-3+ years configuring accumulators and benefit plans or other related experience in payer business logic.
-5+ years of experience as a claims examiner, coder, or other related experience working with medical claims data.
-Experience with adjudication processes, analyzing plan designs, and health plan information systems and applications.
-Knowledge/experience with self-funded, level-funded plan designs.
-Ability to set priorities, manage time, and work independently.
-Demonstrated success getting results through collaboration.
Extra credit:
- Familiarity with the mPhasis, Eldorado, Javelina claims processing software.
-Working knowledge of EDI formats (837/835 claims, 270/271 eligibility) and coding systems (CPT/HCPCS, ICD, DRG).
-Experience in rapidly-growing start-up business environments.
-Understand file types A37, 270, 271, 276, 277, 278 experience.
The salary range for this position is $60,675- $101, 125 annually. Numerous factors including, but not limited to, education, skills, work experience, certifications, etc. will be considered when determining compensation.
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