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Form of workSalary Range: $91,536.00 (Min.) - $121,286.00 (Mid.) - $136,159.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Quality Configuration Assurance Analyst III is responsible for the more complex technical and analytical work related to the testing, validation, and quality assurance of business requirements for and the configuration of the L.A. Care Health Plan core system (i.e., QNXT) and the related surround systems, applications, and database (e.g., Clinical CareAdvance (CCA), Process Communication Tracking (PCT), etc.).
The Quality Configuration Assurance Analyst III collaborates closely with peers and management within the department as well as throughout the organization to facilitate the timely, accurate quality assurance of the systems configuration; indepth analysis of major factors, root causes, etc. that impact member access to care, claims payments, etc.; and assessment and roll-out of key measures to facilitate improvement, where warranted.
Duties
Identify, develop, and recommend new and/or enhanced testing specifications and related documentation. Serve as a subject matter expert for the quality assurance of the configuration of the core and surround systems. Perform the most complex quality audits of the systems configuration. Conduct thorough, in-depth root cause analysis to help identify issues and provide well thought-out recommendations for proposed business process and systems configuration improvements, where warranted.
Interface and collaborate with peers within and outside of the department and the organization to support quality assurance best practices, business process and systems configuration improvements, product enhancements, compliance with established turnaround times and service levels, etc.
Perform other duties as assigned.
Duties Continued
Education Required
Bachelor's Degree
In lieu of degree, equivalent education and/or experience may be considered.
Education Preferred
Master's Degree
Experience
Required:
At least 5 years experience in Systems Configuration, Claims and/or Health Services/Population Health department with demonstrated experience on the following list of knowledge/experience below in a healthcare organization.
Advanced knowledge of and experience in health plan quality assurance (especially related to claims, health services/population health as well as appeals and grievances systems, applications, etc.)
Knowledge of and experience with utilizing SDLC and related change management methodologies, standards and best practices.
Preferred:
At least 5 years experience working with a California Medi-Cal managed care plan or commercial health plan, medical group, or management services organization.
Skills
Required:
Advanced understanding of managed care operations (including but not limited to, claims processing, population health, appeals and grievances, etc.) and the systems that support these operations.
Knowledge of Systems Development Life Cycle (SDLC) procedures in planning the quality assurance (i.e., use of rigorous documentation, testing, and quality assurance protocols pre- and post-deployment).
Strong analytical, organization, and time management skills.
Able to meet strict, tight deadlines with a high level of accuracy.
Able to prioritize multiple tasks.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Light
Additional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Quality Configuration Assurance Analyst III is responsible for the more complex technical and analytical work related to the testing, validation, and quality assurance of business requirements for and the configuration of the L.A. Care Health Plan core system (i.e., QNXT) and the related surround systems, applications, and database (e.g., Clinical CareAdvance (CCA), Process Communication Tracking (PCT), etc.).
The Quality Configuration Assurance Analyst III collaborates closely with peers and management within the department as well as throughout the organization to facilitate the timely, accurate quality assurance of the systems configuration; indepth analysis of major factors, root causes, etc. that impact member access to care, claims payments, etc.; and assessment and roll-out of key measures to facilitate improvement, where warranted.
Duties
Identify, develop, and recommend new and/or enhanced testing specifications and related documentation. Serve as a subject matter expert for the quality assurance of the configuration of the core and surround systems. Perform the most complex quality audits of the systems configuration. Conduct thorough, in-depth root cause analysis to help identify issues and provide well thought-out recommendations for proposed business process and systems configuration improvements, where warranted.
Interface and collaborate with peers within and outside of the department and the organization to support quality assurance best practices, business process and systems configuration improvements, product enhancements, compliance with established turnaround times and service levels, etc.
Perform other duties as assigned.
Duties Continued
Education Required
Bachelor's Degree
In lieu of degree, equivalent education and/or experience may be considered.
Education Preferred
Master's Degree
Experience
Required:
At least 5 years experience in Systems Configuration, Claims and/or Health Services/Population Health department with demonstrated experience on the following list of knowledge/experience below in a healthcare organization.
Advanced knowledge of and experience in health plan quality assurance (especially related to claims, health services/population health as well as appeals and grievances systems, applications, etc.)
Knowledge of and experience with utilizing SDLC and related change management methodologies, standards and best practices.
Preferred:
At least 5 years experience working with a California Medi-Cal managed care plan or commercial health plan, medical group, or management services organization.
Skills
Required:
Advanced understanding of managed care operations (including but not limited to, claims processing, population health, appeals and grievances, etc.) and the systems that support these operations.
Knowledge of Systems Development Life Cycle (SDLC) procedures in planning the quality assurance (i.e., use of rigorous documentation, testing, and quality assurance protocols pre- and post-deployment).
Strong analytical, organization, and time management skills.
Able to meet strict, tight deadlines with a high level of accuracy.
Able to prioritize multiple tasks.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Light
Additional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
