HealthEdge Configuration Analyst

Contract-to-hire

The HealthEdge Configuration Analyst will work as part of a multidisciplinary consulting team to implement the HealthRules Payor (HRP) platform for a health insurance payer client. This role focuses on configuring the HRP platform, collaborating with cross-functional teams to understand business requirements, translating these requirements into system configurations, and ensuring the platform operates efficiently and aligns with the client’s business processes.

Responsibilities

Configuration Management:

• Configure and customize the HRP platform, including benefit plans, provider networks, and business rules, to meet client requirements.
• Ensure compliance with payer-specific guidelines, regulatory requirements, and organizational standards.

Requirements Analysis:

• Collaborate with business analysts, project managers, and client stakeholders to gather and analyze business requirements.
• Translate requirements into technical specifications for system configuration.

Testing and Validation:

• Develop and execute test plans to validate system configurations and ensure accuracy in claim adjudication, member management, and provider integration.
• Troubleshoot and resolve issues identified during testing or post-implementation.

Documentation and Training:

• Document configuration changes, processes, and workflows to ensure traceability and facilitate knowledge transfer.
• Provide training and support to end users and internal teams on the configured HRP platform.

Collaboration and Support:

• Serve as a liaison between the client and technical teams to address configuration needs and system improvements.
• Assist in post-implementation support and enhancements as required.

Requirements

• Strong understanding of HealthEdge HealthRules Payor platform architecture and components.
• Experience with claims processing, benefits configuration, and provider network setup.
• Familiarity with SQL and relational databases for querying and data validation.
• In-depth understanding of healthcare payer operations, including claims adjudication, member management, and provider contracting.
• Familiarity with CMS guidelines, HIPAA compliance, and other regulatory standards.
• Excellent analytical and problem-solving skills.
• Strong written and verbal communication abilities.
• Effective collaboration with multidisciplinary teams in a consulting environment.
• Previous experience working in consulting roles for healthcare payers.
• Exposure to agile project management methodologies.

Education and Experience

• Bachelor’s degree in Computer Science, Information Systems, Healthcare Administration, or a related field.
• 3+ years of experience configuring and implementing healthcare payer platforms, preferably HealthRules Payor (HRP).