QNXT Benefits Configuration Analyst

Job Title: QNXT Benefits Configuration Analyst
Location: Remote, Worcester, MA.  EST candidates only
Duration: 6+ months
Type: C2C
Interview Mode: Video



Job Description:

Visa: No H1B/TN

Need 2 managerial references and candidate should not be submitted prior to
Beacon hill company 


Looking for a QNXT Benefits Configuration Analyst
Making changes to the Benefits side, not systems side.

The benefit plans for the year have all been configured, this is more to make changes to
plans to keep up with changing regulation policies. Will need to perform
testing and validation, and review authorization requirements.

Must Haves:
QNXT
Testing and Validation

• Authorization requirements

• Responsible for translating standard and complex and varied business needs into Client Health configuration rules. To be successful, must possess the technical expertise of the required operational phases of the business systems and analysis skills to translate the information accurately.  Business acumen is essential to fully understandthe implications of the configuration role on other interrelated businesses related to benefits and provider contracts.

• The configuration work for which this role is responsible impacts the end result of our health plans as well as the quality of our claims operations, customer care operations, and cost containment & recovery operations.  With a strong dedication to excellent quality of work, ensures that our members and providers have a positive experience as part of the Client Health network, and that we pay claims correctly and on time, avoiding fines and extra costs. 

• The benefit & provider configuration team is responsible to ensure that claims payment and benefits are correctly configured in context of medical policies, reimbursement policies, clinical editing policies, CMS requirements and contract details.  Accurate systems configuration ensures the correct adjudication of claims and processing of provider payments for the providers in the Client Health managed care networks

• 3-7 years’ experience with QNXT or similar database is required in Healthcare Administration

• Strong operational knowledge of commercial/regulatory health provider industry

• Prior experience working with and responding to customer service cases, claims administration, enrollment or appeals and grievances related to inaccurate configuration information

• Experience of benefit configuration with the ability to analyze and translate complicated data into useful information

• Understanding of industry standard code sets, government regulations as mandated by the regulatory agencies such as NCQA, CMS, NPI.

• Strong analytical & quantitative skills to identify member or provider impacts downstream as a result of invalid configuration.

• Intermediate Microsoft Office experience with an emphasis on MS Excel and Access skills in order to manipulate and communicate complex data; MS Access or SQL knowledge preferred