Associate Configuration Support Analyst -CBC, Rockville, MD
Company Name:
Kaiser Permanente
Analyst is responsible for the management and maintenance of benefit configuration in the BETS, HealthConnect, KMATE, and Diamond Claims system to support accurate and timely payment or adjudication of claims, benefit administration (such as: Member out of pocket maximums) and EOC production and generation.
Essential Functions:
- Ensures the accurate translation of the benefits to the Book Logic Table for accurate production of the EOC and Group Agreements.
- Ensures benefit information is translated from source documents to the BETS system so accurate benefit configuration is available in supporting systems.
- Ensures configuration accuracy meets or exceeds Regional metrics.
- Is responsible for maintaining integrity of BETS, HealthConnect, KMATE, DIAMOND benefit information and other systems as applicable.
- Ensures demographic, rate, and benefits are assigned to groups on sale or renewal.
- Ensures benefit configuration meets established business rules and procedures.
- Develops and executes test plans for configuration testing, reports on outcome.
- Acts as liaison between Contract Benefit Configuration and other departments regarding system configuration and functionality.
- Modifies the systems: BETS, HealthConnect, KMATE, DIAMOND, and other systems as applicable configuration to reflect source documentation.
- Ensures that deliverables produced meet quality, cost, and turnaround metrics.
- Consults with relevant department to determine appropriate interpretation and configuration of benefit information.
- Performs Group Transfers.
- Ensures effective coordination of work activities and objectives with others.
- Validates that the completion of administrative requirements is met in a timely and accurate manner.
- Maintains detailed knowledge and understanding of benefit configuration in all systems.
- Performs problem resolution of configuration issues.
- Escalates concerns, issues or discrepancies to management team.
- Responsible for peer-to-peer quality assurance support and oversight.
Qualifications:
Basic
Qualifications:
Experience
- Minimum three (3) years of experience in business process processes, reporting or auditing in a health care environment required.
Education
- Associate's degree in healthcare administration, business administration or a health profession required, or two (2) years of experience in health care, preferably in an HMO setting.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
Additional Requirements:
- N/A
Preferred
Qualifications:
- Project Coordination experience is recommended.
- Coordination of tasks/resources is recommended.
- Managed care experience preferred.
- Working knowledge of KMATE, BETS, DIAMOND, KPHC configurations is preferred.
- Work as a project team member as Subject Matter Expert (SME) is preferred.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.Estimated Salary: $20 to $28 per hour based on qualifications.
Kaiser Permanente
Analyst is responsible for the management and maintenance of benefit configuration in the BETS, HealthConnect, KMATE, and Diamond Claims system to support accurate and timely payment or adjudication of claims, benefit administration (such as: Member out of pocket maximums) and EOC production and generation.
Essential Functions:
- Ensures the accurate translation of the benefits to the Book Logic Table for accurate production of the EOC and Group Agreements.
- Ensures benefit information is translated from source documents to the BETS system so accurate benefit configuration is available in supporting systems.
- Ensures configuration accuracy meets or exceeds Regional metrics.
- Is responsible for maintaining integrity of BETS, HealthConnect, KMATE, DIAMOND benefit information and other systems as applicable.
- Ensures demographic, rate, and benefits are assigned to groups on sale or renewal.
- Ensures benefit configuration meets established business rules and procedures.
- Develops and executes test plans for configuration testing, reports on outcome.
- Acts as liaison between Contract Benefit Configuration and other departments regarding system configuration and functionality.
- Modifies the systems: BETS, HealthConnect, KMATE, DIAMOND, and other systems as applicable configuration to reflect source documentation.
- Ensures that deliverables produced meet quality, cost, and turnaround metrics.
- Consults with relevant department to determine appropriate interpretation and configuration of benefit information.
- Performs Group Transfers.
- Ensures effective coordination of work activities and objectives with others.
- Validates that the completion of administrative requirements is met in a timely and accurate manner.
- Maintains detailed knowledge and understanding of benefit configuration in all systems.
- Performs problem resolution of configuration issues.
- Escalates concerns, issues or discrepancies to management team.
- Responsible for peer-to-peer quality assurance support and oversight.
Qualifications:
Basic
Qualifications:
Experience
- Minimum three (3) years of experience in business process processes, reporting or auditing in a health care environment required.
Education
- Associate's degree in healthcare administration, business administration or a health profession required, or two (2) years of experience in health care, preferably in an HMO setting.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
Additional Requirements:
- N/A
Preferred
Qualifications:
- Project Coordination experience is recommended.
- Coordination of tasks/resources is recommended.
- Managed care experience preferred.
- Working knowledge of KMATE, BETS, DIAMOND, KPHC configurations is preferred.
- Work as a project team member as Subject Matter Expert (SME) is preferred.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.Estimated Salary: $20 to $28 per hour based on qualifications.
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