Health Plan Business (Facets) Configuration Analyst - Health Alliance Plan

Company Description

Health Alliance Plan by Henry Ford Health is a Michigan-based, nonprofit health plan that provides health coverage to individuals, companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.

Job Description

GENERAL SUMMARY:

This role sits at the intersection of business, IT, and operations—owning system configuration, ensuring compliance, driving quality, and enabling efficient issue resolution and system enhancements.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Initiate the analysis of, and ensure adequate evaluation of, system impacts. Serve as the system expert for customer bases and IT departments.
• Prepare recommendations for enhancements to system applications/vendors.
• Coordinate BCT efforts and customer needs to ensure expeditious response and resolution of system problems/issues.
• Perform ongoing quality review checks to ensure a superior product for on-going production support.
• Responsible for the performance of the application software based on customer requirements and ensuring that systems conform to Government Programs, and Regulatory Agency Standards.
• Assist in the analysis and testing of new Facets releases while identifying the impact to interfaces for externally developed packages.
• Participate in corporate project meetings to disseminate the customer's needs and priorities to corresponding team leadership.
• Interact with other departments and divisions within Health Alliance Plan and Henry Ford Health to establish consistent interpretation of various policies and procedures throughout the system.
• Perform other related duties as assigned.

Qualifications

• EDUCATION/EXPERIENCE REQUIRED:

• Bachelor’s degree in computer science or business administration.

• Related and relevant experience may be considered in lieu of academic requirements. Related experience is defined as six (6) years’ experience in Health Care related business and/or claims processing system configuration.

• Two (2) years of claims processing system configuration experience or demonstrated proficiency through relevant Health Alliance Plan specific business experience.

• Preferred:

• Five (5) years of Health Care related business experience preferred.

• Knowledge of Facets claims processing with the ability to troubleshoot.

• Ability to work at a fast pace in a constantly changing environment.

• Ability to Interpret Member and Group contracts and translate into Benefit configuration.

• Analytical thinking required for troubleshooting configuration-related defects

• Experience developing Service IDs, Supplemental Mapping, Service Rules, Variable Components, Product Component Configuration in Facets.

• Knowledge of Facets Group, billing, class/plan configuration in Facets

• Experience in open enrollment processes preferred (new Plan/Product creation, passive enrollment, Mass member transfer etc.)

• Knowledge of claim processing, accumulators, provider reimbursement, member eligibility and authorizations

• SQL experience preferred (Oracle and SQL Server)

• Certified Medical Coder preferred

• Demonstrated ability to research, analyze, design, plan, organize, coordinate, implement, and perform necessary follow-up and closure procedures for system related projects.

• Demonstrated ability to collect and prepare data for written/oral presentations.

• Demonstrated ability to communicate effectively.

• Ability to interact with outside sources and maintain professional contacts.

• Excellent written and verbal communication skills are essential.

• Must be able to work effectively with persons of varying position levels and diverse interests.

• Understanding of healthcare industry and managed care concepts.

• Knowledge of a table-driven claims processing system.

• Knowledge of Windows, Microsoft Excel and Word, Query Tools (COGNOS, etc.) and Implementation/Administration of Packaged Claims Processing Applications.

• A high level of human relations skills.

• Ability to adapt to a constantly changing environment.