Configuration Analyst - Configuration System
At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.
Analyze and configure AMISYS to calculate appropriate benefit determinations and health claim reimbursement for multiple business lines with direction. Support system configuration, tables and codes which translate Paramount Health Care’s business policies into high quality, timely and efficient system configuration in order to provide accurate claims payment, reimbursement and administration of multiple products in a managed care environment.
1. Creates and maintains the integrity of all AMISYS configuration to support claim adjudication, including but not limited to benefits determination, accumulator/counter, and coding protocols.
2. Creates and maintains the integrity of all AMISYS configuration to support provider reimbursement, including but not limited to provider contract configuration, capitations reimbursement, and fee schedule administration.
3. Recommends system solutions and alternatives that meet business objectives.
4. Develops and maintains a comprehensive understanding of AMISYS and related Paramount Health Care business applications. Participates in the testing of AMISYS release upgrades.
5. Work cooperatively with System Configuration Manager on systems questions. Attend appropriate meetings to determine current system design needs.
6. Assist in maintaining written documentation to support system configuration.
7. Work directly with Configuration Analyst 3 to extract data from AMISYS subsystem through end user reporting tool.
8. Performs other related projects and duties as assigned to ensure efficient claims payment and processing.
⦁ Associate Degree or an equivalent combination of education and experience in a health care environment performing system configuration or analysis/support of claim adjudication required.
⦁ A minimum of three years’ experience in the administration of health care benefits, administration policies or provider reimbursement policies and mechanisms required.
⦁ Knowledge of medical terminology coding protocols, provider reimbursement, and benefit structures strongly preferred.
⦁ Certification in at least one AMISYS claims subsystem required within 12 months in position.
⦁ Familiarity with managed care business concepts required (e.g. administration, benefits administration, or medical reimbursement).
⦁ Knowledge of word processing, spreadsheet, and database skills required.
⦁ Demonstrated ability to maintain detailed and confidential information.
⦁ Excellent oral and written communication and interpersonal skills required.
⦁ Ability to move between company workstations and departments.
ProMedica is a mission-based, not-for-profit health and well-being organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 49,000 employees, 12 hospitals, 2,500+ physicians and advanced practice providers with privileges, 1,000+ healthcare providers employed by ProMedica Physicians, a health plan, and 330+ assisted living facilities, skilled nursing and rehabilitation centers, memory care communities, and hospice and home health care agencies. Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. For more information about ProMedica, please visit www.promedica.org/aboutus.
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.
Equal Opportunity Employer/Drug-Free Workplace
My Saved Jobs
You have no saved jobs.