Network Administration Analyst Job

Children's Health - General Careers

Job Number: 53272

Location: Dallas, TX

Date Posted: 12-9-2017

Description:

POSITION SUMMARY:

This is an analytical position requiring configuration of core business processing systems in a health plan services setting. It requires using intelligence and judgment to provide solutions for operational business needs.

JOB SPECIFIC RESPONSIBILITIES:

  • Provides reporting to assure compliance for all regulatory and accreditation body requirements.
  • Performs updates to provider records in the claims system for demographic and other changes.
  • Develops, implements and drives best practices for claims adjudication in conjunction with claims and network contracting.
  • Supports root cause analysis for systemic claims payment issues and provides timely, effective resolution.
  • Analyzes business requirements and objectives towards determining the optimal configuration of the requirements used to support health plan operations.
  • Assures quality targets are met in relation to contract set-up.
  • Performs configuration-related activities to meet project deadlines.
  • Participates in requirements development sessions with health plan business owners and other team members.
  • Provides in-depth knowledge of company-wide business processes.
  • Works with business owners to ensure that all application and technically-oriented issues relating to the configuration project are appropriately addressed.

EXPERIENCE:

Two or more years of technical and/or systems experience in an HMO required

Experience using QNXT claims software preferred

EDUCATION:

Four-year Bachelor's degree or equivalent experience preferred

Specific Knowledge, Skills and Abilities:

  • Please list the specific skills and abilities that an incumbent must possess to perform the position properly.
  • Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
  • Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
  • Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
  • Develop and use collaborative relationships to facilitate the accomplishment of work goals.
  • Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
  • Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
  • Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
  • Effectively manage one's time and resources to ensure that work is completed efficiently.
  • Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
  • Assimilate and apply new job-related information in a timely manner.
  • Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.

PHYSICAL DEMANDS:

Sedentary - Exerting up to 10lbs. occasionally or negligible weights frequently; sitting most of the time.


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