Program analyst [h1.location_city]

Location : Avera Health Plans

Worker Type : Regular

Work Shift :

Day Shift (United States of America)

Pay Range :

The pay range for this position is listed below. Actual pay rate dependent upon experience.

$49920.00 - $75920.00

Position Highlights

Looking for Candidate with Medical Coding background.

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

The Avera Health Plan Configuration Analyst is responsible for the design implementation and support of the Epic Tapestry module which manages health plan administration benefits fee schedules claims enrollment care coordination clinical / authorizations and provider data. This role ensures that managed care workflows are optimized and aligned with organizational goals regulatory requirements and member-centered care initiatives. As a Configuration Analyst you will work closely with clinical operational and technical stakeholders to translate complex business needs into efficient system solutions while maintaining the integrity and performance of Epic applications.

What you will do

• System Configuration & Optimization : Build test implement and maintain Epic Tapestry components and functional workflows. Converting benefit plan requirements into system configurations collaborating with other analysts and business leaders ensuring data accuracy customizing settings to support payer-provider relationships and supporting the systems ongoing performance. Develop and improve workflows and business processes to improve customer service decrease operational administrative costs and improve overall health plan outcomes and quality. Collaborate with Epic and internal teams to implement and test new features and enhancements on a quarterly basis.
• System Support & Troubleshooting : Provide support for Epic Tapestry-related issues including performing root-cause analysis resolution documentation of results and present business impact analysis for proposed configuration changes. Monitor existing system performance and make configuration recommendations where appropriate to maintain acceptable levels of automation in claims adjudication and member enrollment workflows and accurate claims payment.
• Stakeholder Collaboration : Partner with internal teams including health plan business and functional operations teams Avera system stakeholders for other Epic applications and IT staff to ensure accurate and compliant system configurations. Work closely with operational teams to interpret functional operating procedures and align system capabilities with operational goals. Provide input on system design to improve efficiency and reduce administrative burden. Collaborate with data integration and reporting teams to ensure data consistency and performance.
• Requirement Analysis : Uses experience and judgement to plan and accomplish goals; performs a variety of complicated tasks to ensure that the core claims system is configured correctly by reviewing the system components and validating that the configuration aligns to legal plan documents and regulatory requirements. Interpret and analyze plan documents such as Evidence of Coverage (EOCs) fee or rate schedules policies code set changes and translate into technical specifications for the system.
• Data management : Provides analysis and documentation that supports configuration management design requirements traceability and audit controls needed to meet state and federal regulatory requirements. Work with Epic Chronicles and data models and understand relevant EDI (Electronic Data Interchange) formats like 834 837 and 835.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others hear understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge skills and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions as long as the accommodations do not cause undue hardship to the employer.

Required Education License / Certification or Work Experience :

Preferred Education License / Certification or Work Experience :

Expectations and Standards

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced healthy lives. Benefits are designed to meet needs of today and into the future.

PTO available day 1 for eligible hires.

Up to 5% employer matching contribution for retirement

Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability Veteran Status or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application please call 1- or send an email to .

Required Experience :

IC

Key Skills

Digital Electronics,Gallery,Learning Management System,Autocad,Computer Engineering

Employment Type : Full-Time

Experience : years

Vacancy : 1

Monthly Salary Salary : 49920 - 75920