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Form of workJob Requisition ID: 10651
Under the direction of the Director of Business Systems & Transformation, the Analyst III - Member Data Configuration is responsible for developing and maintaining the high-level configuration plan for the Member Business Systems and will provide guidance and recommendations based on Member System functionality, regulatory requirements, and have business acumen. The Analyst III - Member Data Configuration will work together with various business units in the organization and participate in projects to evaluate and implement configuration methodologies, leveraging systematic algorithms. The Analyst III - Member Data Configuration will work closely with leadership and business stakeholders to ensure that regulatory and contractual guidelines are met, and use of appropriate configuration standards and automation are developed and utilized in IEHP. The Analyst III - Member Data Configuration is responsible for the successful delivery of membership systems configurations and the optimization of related components and will act as a subject matter expert on technical and business matters and assume a lead role for the Business Systems & Transformation team.
1. Identify the needs to drive optimization and automation enhancements to membership systems and other enterprise transformation initiatives to meet the needs of IEHP business functionality.
2. Subject matter expert (SME) for complex Membership System algorithms, business logic, data mapping and process engine outcomes.
3. Designs, tests, and implements system infrastructure for various Member Eligibility Systems.
4. Partner with all levels of management, data analysts, application vendors, and other relevant staff to maintain proficiencies for constantly evolving industry standards and practices to deploy and optimize Member System application architectures.
5. Collaborate with and guide a team of analysts with membership systems configuration design, development, and optimization.
6. Coordinate and work closely with software vendors and Application Support teams to identify, evaluate, test, implement and tune system enhancements and integrated software.
7. Design and develop test plans, audits, and batch jobs to ensure quality and process efficiency and lead in their execution and validation, while performing Debugging and Root Cause Analysis on test failures as needed.
8. Develop and draft Business Requirement Documents (BRDs), Enhancement Requests (ERs), Change Requests (CRs), Business Rule Change Request (BRCRs), and other decision recommendation documents as required.
9. Responsible to analyze and translate complex business logic, data mapping and business specification requirements into technical specifications and vice versa, based on eligibility data from governing agencies and system functionality and redesign and optimize processes whenever possible to increase efficiency for all lines of businesses.
10. Maintain a comprehensive understanding of the Member Data system features and capabilities in order to provide effective support to the organization.
11. Identify, design, and communicate impact of system enhancements or configuration changes on integrated systems and processes.
12. Apply LEAN/A3 methodologies to business process and system configuration design and development.
13. In conjunction with BST (Business Systems & Transformation) Analysts, research complex eligibility issues for Medicare, Medi-Cal and Covered CA, as well as identify new opportunities in the Membership Systems to improve processes and performance, while reducing manual intervention of repetitive tasks.
14. Partner with IT and external application vendors to apply robotic process automation to redesign processes and automate relevant tasks that meet the needs of business and regulations.
15. Train, mentor, and guide teammates on optimization and automation capabilities.
16. Any other duties as required ensuring Health Plan operations are successful.
A minimum of five (5) years of business systems analysis, configuration and healthcare experience required, including the design, development, validation, and/or implementation of complex systems within a healthcare setting. In addition, candidate must have experience working with Medicare, Medicaid, and Covered CA government programs and regulatory agencies.
Bachelor’s Degree in Business Administration, Health Care Administration, Computer Information Systems (CIS), Management Information Systems (MIS), or other related field from an accredited institution required.
In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position: two (2) years of general healthcare experience plus two (2) years of configuration experience is required. This experience is in addition to the minimum years listed in the Experience Requirements above.
Strong understanding of Member system processing, membership configuration, concepts, principles, and best practices. Knowledge of CMS, DHCS, DMHC, NCQA rules and regulations preferred. Extensive knowledge of general managed care operations required. Proficient knowledge of SQL and relational database structure required. Knowledge of 834 5010 file format including codes and guidelines. Knowledge of eligibility file processing for multiple lines of businesses preferred.
Functional knowledge of IEHP membership systems including Core Membership and Eligibility File Processing, IEHP membership databases, and the MHK suite, are highly preferred. In addition, working knowledge of vendor systems including HealthTrio and HealthEdge HRP are preferred.
Strong organizational skills, problem solving, and critical thinking skills required. Intermediate skill level in Microsoft Excel required. Experience using Workfront a plus. Strong presentation and written communication skills required as well as excellent communication and interpersonal skills. Must be detail oriented.
Demonstrate leadership capabilities. Ability to work independently and solve complex problems with little to no assistance required. Ability to effectively manage multiple competing priorities. Strong work ethic and highly self-motivating and directing required. Successful working in a team oriented, collaborative, and changing environment required. Highly creative and willing to learn and think outside the box.
The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.
A reasonable salary expectation is between $91,000.00 and $116,022.40, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
