Overview
Skills
Job Details
QNXT Benefits Configuration with Medicaid experience (preferably from a Florida health plan)
As a QNXT Benefits Configuration Specialist with experience in Medicaid, preferably from a Florida health plan, you will play a critical role in configuring, maintaining, and optimizing our QNXT (QNXT is a widely used health plan administration system developed by TriZetto, a Cognizant Company) benefits system to ensure accurate and efficient processing of Medicaid benefits for our members. You will collaborate closely with various stakeholders including IT, Operations, and Compliance teams to implement changes, troubleshoot issues, and enhance system functionality.
Responsibilities:
Configure and maintain QNXT benefits system to support Medicaid benefits offerings according to state regulations and plan requirements.
Collaborate with business stakeholders to gather requirements and translate them into technical specifications for system configuration.
Develop and implement benefit plan designs, including but not limited to eligibility rules, benefit packages, provider contracts, fee schedules, and reimbursement methodologies.
Ensure accuracy and completeness of benefit configurations by conducting thorough testing and validation of system changes.
Analyze and resolve configuration-related issues, working closely with IT support teams and vendor partners as needed.
Stay informed about regulatory changes and industry trends impacting Medicaid benefits, and proactively update system configurations to maintain compliance.
Provide training and support to internal users on QNXT benefits configuration processes and best practices.
Participate in cross-functional projects and initiatives aimed at improving operational efficiency, member satisfaction, and overall business performance.
Document configuration changes, issues, and resolutions in accordance with organizational standards and procedures.
Continuously identify opportunities for process improvements and automation to streamline benefit configuration workflows.
Qualifications:
Bachelor's degree in Healthcare Administration, Information Systems, or related field.
Minimum of 3 years of experience in benefits configuration within a healthcare organization, preferably with a focus on Medicaid programs.
Proficiency in QNXT system configuration and administration, with specific experience in Medicaid benefits configuration highly preferred.
Strong understanding of Medicaid regulations, policies, and procedures, particularly in the state of Florida.
Excellent analytical and problem-solving skills, with the ability to troubleshoot complex configuration issues and propose effective solutions.
Solid project management skills with the ability to manage multiple priorities and deadlines simultaneously.
Strong communication and interpersonal skills, with the ability to effectively collaborate with cross-functional teams and communicate technical information to non-technical stakeholders.
Detail-oriented approach with a commitment to accuracy and quality in all aspects of work.
Ability to adapt to change and thrive in a fast-paced, dynamic environment.
Certification in QNXT configuration or related healthcare IT certifications is a plus.