Analyst II - Product System Configuration

Salary : $80,000 - 120,000 per year

Requirements :

• Four years of experience with the development and remediation of moderately complex system configurations, including capitated provider agreement configurations.
• Bachelor's degree from an accredited institution is required. In lieu of the required degree, a minimum of four years of additional relevant work experience is necessary for this position.
• Two years of general healthcare experience and two years of configuration experience are required.
• Knowledge of Medicare and Medi-Cal fee schedules and benefit structure, as well as regulatory billing guidelines, is required.
• Preferred knowledge includes CMS, DHCS, DMHC, and NCQA rules and regulations.
• Extensive knowledge of CPT, HCPCS, Revenue, and ICD10 coding rules and guidelines is preferred.
• Comprehensive understanding of general managed care operations is required; familiarity with a delegated plan model is preferred.
• Basic knowledge of relational database structure.
• Advanced knowledge of Product System algorithms and processes is preferred.
• Familiarity with basic medical product processing is preferred.

Responsibilities :

I assist with the development of configuration standards and best practice guides to maintain efficiency, accuracy, automation, and successful integration with internal and external systems and programs.

I analyze and translate business specifications into detailed technical specifications based on system functionality and develop non-systematic workaround processes when necessary.

I perform product system error root cause analysis.

I track incoming requests and issue resolution through Microsoft Access, MediTrac, and Workfront tools.

I identify and communicate the impact of system enhancements or configuration changes on integrated systems and processes.

I monitor the daily System Configuration inventory and ensure compliance with established service level agreements and regulatory timelines.

I configure and maintain complex product-related system builds with multi-tiered functionality and interrelated system dependencies, including Contracts, Benefits, Fee Schedules, and Service Categories.

I assist the Contracting team with drafting appropriate contract fee schedule language in line with system adjudication capabilities and coding standards.

I develop and maintain business requirements for the automation of coding updates.

I track, test, and approve new system functionality, enhancements, and bug fixes, including the development and execution of test plans and scripts.

I perform weekly and bi-weekly audits of check run products to proactively identify potential system configuration issues before products are released.

I undertake other duties as assigned, including participation in Department Projects and LEAN / A3 Events.

Technologies :

CMS

More :

At IEHP, we find joy in serving others, and we welcome you to join us in “healing and inspiring the human spirit.” We aim to transform a job opportunity into an authentic experience. As part of our team, we are committed to incorporating our Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation.

We are not only dedicated to the wellbeing of our Members; we also strive to provide our Team Members with prime benefits and more. Our offerings include CalPERS retirement, a 457(b) option with a contribution match, generous paid time off (vacation, holidays, and sick days), an on-site state-of-the-art fitness center, medical insurance with dental and vision coverage, paid life insurance with additional options, short-term and long-term disability options, pet care insurance, flexible spending accounts for health care and childcare, wellness programs promoting a healthy work-life balance, career advancement opportunities, professional development, a competitive salary with an annual merit increase, and team bonus opportunities.

last updated 50 week of 2025