Administrative Systems Analyst I, Ii Or Iii

PEHP Health & Benefits is a division of the Utah Retirement Systems that proudly serves Utah’s public employees through high quality and competitively priced medical, dental, life, and long-term disability insurance plans on a self-funded basis. As a government entity, we embrace both a public mission and a commitment to creating customer value, excelling in the market, and improving healthcare. We offer a competitive salary with generous benefits, personal development in a positive team environment, and excellent work-life balance.

ADMINISTRATIVE SYSTEMS ANALYST I

FLSA NON-EXEMPT

MIN $21.77/HR. MAX $27.21/HR.

Position Summary

PEHP’s Administrative Systems Team plays a mission critical role in making PEHP’s core administrative systems a competitive strength. The Administrative Systems Analyst I (Analyst) is responsible for assisting with the evaluation, testing, and implementation of required benefits and payment structure changes within the PEHP Administrative Systems. The Analyst must possess strong analytical skills, with the ability to perform complex business and product set up requirement analysis. Successful performance in this position will require a strong understanding of the benefits systems, the ability to analyze and problem solve simple to complex projects, and the ability to work semi-independently and within deadlines.

Essential Job Functions And Duties

• Performs other duties as required.
• System Configuration
• Assists in the setup of code sets and clinical guidelines used in benefits configuration and provider payments.
• Process Optimization
• Documentation and Communication
• Helps track incoming requests and issue resolutions through productivity monitoring tools.
• Ensures the quality and integrity of implementation of benefits change requests by assisting with production validation and audits.
• Collects and analyzes data to assess and resolve operational obstacles to benefits design optimization.
• Identifies ways to enhance operational reports related to new business implementation processes.
• Assists with the development of configuration standards and best practice guidelines, making recommendations where appropriate.
• Helps develop explanatory information for other departments to better understand administrative system configuration.
• Provides project and informational updates to management as available and/or assigned.
• Aids in the creation of test scripts, including regression testing cases, to validate system configuration against source documentation; tracks and tests new system functionality, enhancements, and bug fixes, including the development and execution of test plans.
• Maintains a strong understanding of the HealthRules Payor and HealthRules Care Manager systems features and capabilities, associated interfaces, and dependencies with other internal and third-party systems.
• Analyzes explanation of benefits documents and master policies to ensure correct and efficient implementation.
• Assists with organizing the release of benefits configurations changes to production to reduce the potential for migration conflict.
• Assists with root-cause analysis on benefit set up issues and proposed set up changes.
• Maintains strict confidentiality in compliance with applicable federal and state law and PEHP policy.
• Applies Lean principles and methodologies to process and workflow designs.
• Assists in the on-going evaluation of benefits configuration for new and existing benefit plans within HealthRules Payor, HealthRules Care Manager, and all associated interfaces and third-party systems.

ADMINISTRATIVE SYSTEMS ANALYST II

FLSA NON-EXEMPT

MIN $25.87/HR. MAX $32.33/HR.

Position Summary

PEHP’s Administrative Systems Team plays a mission critical role in making PEHP’s core administrative systems a competitive strength. The Administrative Systems Analyst II (Analyst) is responsible for helping lead the evaluation, design, testing, and implementation of required benefits and payment structure changes within PEHP Administrative Systems. The Analyst must possess strong analytical skills, with the ability to perform complex business and product set up requirement analysis for all administrative systems environments. Successful performance in this position will require a thorough understanding of the benefits systems, the ability to analyze and problem solve simple to complex projects, and the ability to work independently and within deadlines.

REPORTING RELATIONSHIPS

Works under the direct supervision of the Administrative Systems Senior Manager.

Essential Job Functions And Duties

• Maintains a comprehensive understanding of the HealthRules Payor and HealthRules Care Manager systems features and capabilities, associated interfaces, and dependencies with other internal and third-party systems.
• Provides feedback/input in the development of training materials
• Leads the creation of test scripts, including regression testing cases, to validate system configurations against source documentation; tracks and tests new system functionality, enhancements, and bug fixes, including the development and execution of test plans.
• Analyzes explanation of benefits documents, benefit grids, and master policies to ensure correct and efficient implementation.
• Identifies ways to enhance performance management and operational reports related to new business implementation processes.
• Ensures proper setup of code sets and clinical guidelines used in benefits configuration and provider payments and reviews work performed by other Analysts.
• Provides project and informational updates to management as available and/or assigned.
• Process Optimization
• Ensures the quality and integrity of implementation of benefits change requests through the use of production validation and audit strategies.
• Documentation and Communication
• System Configuration
• Provides project and informational updates to management as available and/or assigned.
• Acts as a liaison and subject matter expert (SME) with applicable departments to evaluate benefits and policy configuration requirements and provide feedback to stakeholders regarding feasibility of change implementation.
• Leads the on-going evaluation of benefits configuration for new and existing benefit plans within HealthRules Payor, HealthRules Care Manager, and all associated interfaces and third-party systems.
• Develops configuration standards and best practice guidelines for maintaining and improving efficiency, accuracy, automation, and successful integration with internal and external systems and programs.
• Collects and analyzes data to assess and resolve operational obstacles to benefits design optimization.
• Applies Lean principles and methodologies to process and workflow designs.
• Performs root-cause analysis on benefit set up issues across all products, document results, and present business impact analysis for proposed benefits set up changes.
• Collaborates with business units to understand strategic goals and promote an environment conducive to creativity, change, and information exchange.
• Maintains strict confidentiality in compliance with applicable federal and state law and PEHP policy.
• Performs other duties as required.
• Develops explanatory information for other departments to better understand administrative system configurations and interfaces across all products.
• Helps coordinate the release of benefits configuration changes to production to reduce the potential for migration conflict.

ADMINISTRATIVE SYSTEMS ANALYST III

FLSA EXEMPT

MIN $64,420/YR. MAX $82,124/YR.

Position Summary

PEHP’s Administrative Systems Team plays a mission critical role in making PEHP’s core administrative systems a competitive strength in delivering market competitive products, services, and experience to our members. The Administrative Systems Analyst III (Analyst) is a seasoned professional responsible for helping lead the evaluation, design, testing, and implementation of required benefits and payment structure changes within PEHP Administrative Systems. The Analyst must possess strong analytical skills with the ability to perform complex business and product set up requirement analysis for all administrative systems environments. Successful performance in this position will require a thorough understanding of the benefits systems, the ability to analyze and problem solve simple to complex projects, and the ability to work independently and within deadlines.

REPORTING RELATIONSHIPS

Works under the direct supervision of the Administrative Systems Senior Manager.

Essential Job Functions And Duties

• Ensures proper setup and documentation of systems configuration and reviews work performed by other Analysts.
• System Configuration
• Performs root-cause analysis on benefit set up issues across all products, document results, and present business impact analysis for proposed benefits set up changes.
• Leads the on-going evaluation of configuration for new and existing system components within HealthRules Payor, HealthRules Care Manager, and all associated interfaces and third-party systems.
• Provides feedback/input in the development of training materials.
• Process Optimization
• Documentation and Communication
• Collects and analyzes data to assess and resolve operational obstacles to benefits design optimization.
• Acts as a liaison and subject matter expert (SME) with applicable departments to evaluate benefits and policy configuration requirements and provide feedback to stakeholders regarding feasibility of change implementation.
• Collaborates with business units to understand strategic goals and promote an environment conducive to creativity, change, and information exchange.
• Provides project and informational updates to management as available and/or assigned.
• Supports the Administrative Systems Senior Manager as the HealthEdge SME within PEHP. Maintains a comprehensive understanding of the HealthRules Payor and HealthRules Care Manager systems features and capabilities, associated interfaces, and dependencies with other internal and third-party systems.
• Provides project and informational updates to management as available and/or assigned.
• Identifies ways to enhance performance management and operational reports related to new business implementation processes.
• Performs other duties as required.
• Maintains strict confidentiality in compliance with applicable federal and state law and PEHP policy.
• Coordinates the release of configuration changes to production to reduce the potential for migration conflict.
• Ensures the quality and integrity of implementation of systems change requests through the use of production validation and audit strategies.
• Develops explanatory information for other departments to better understand administrative system configurations and interfaces across all products.
• Applies Lean principles and methodologies to process and workflow designs.
• Leads the creation of test scripts, including regression testing cases, to validate system configurations against source documentation; tracks and tests new system functionality, enhancements, and bug fixes, including the development and execution of test plans.
• Supports the Administrative Systems Senior Manager in leading configuration, testing, and operations of PEHP core administrative systems including upgrades and ensuring interfaces with other internal and third-party systems are functioning properly, working with PEHP Development Applications and IT where necessary to troubleshoot and resolve interface issues.
• Coordinates efforts with PEHP Development Applications and IT Systems Analysts regarding other system design, database files, content needs, and logic specifications of necessary applications and any needed upgrades.
• Develops configuration standards and best practice guidelines for maintaining and improving efficiency, accuracy, automation, and successful integration with internal and external systems and programs.
• Works closely with Administrative Systems Senior Manager, project sponsors, cross-functional teams, and assigned project managers to plan and develop scope and deliverables for system implementations and upgrades.

ADMINISTRATIVE SYSTEMS ANALYST I

Minimum Qualifications

Education and Experience

High School diploma and four (4) years of relevant managed care/health plan business analysis or system software configuration experience, or an equivalent combination of education and experience is required.

Bachelor's degree with a strong emphasis in information technology, information systems, business, data analytics, or some other related field is strongly preferred.

PEHP Experience Is Preferred.

Experience with HealthRules Payor and HealthRules Care Manager preferred.

Knowledge, Skills, And Abilities

This list contains knowledge, skills, and abilities that are typically associated with the job. It is not all-inclusive and may vary from position to position

Required technical skills include the intermediate knowledge and ability of

• Implementation processes within a claims operations or product management environment.
• Familiarity with medical terminology, medical coding (CPT4, ICD10, and HCPCS), provider contract concepts, and common claims processing/resolution practices.
• Microsoft Excel.
• Project tracking, testing, and requirement tools (Microsoft Project, SharePoint, JIRA).
• Gathering, analyzing, and communicating complex requirements in a simple and easy to understand manner to both technical and non-technical staff.

Required working knowledge of

• PEHP standards and contract compliance.

Must possess excellent communication skills

• Communicate effectively with technical and non-technical members of various departments.
• Respond professionally to common inquiries or complaints.

Must have the ability to

• Prioritize work, multi-task, follow through with assignments, and perform within deadlines.
• Deal effectively with stress caused by workload and time deadlines.
• Work well in a team environment as well as independently.
• Follow written and verbal instructions.
• Maintain a strong attention to detail.

ADMINISTRATIVE SYSTEMS ANALYST II

Education and Experience

High School diploma and six (6) years of relevant managed care/health plan business analysis or system software configuration experience, or an equivalent combination of education and experience is required.

Bachelor's degree with a strong emphasis in information technology, information systems, business, data analytics, or some other related field is strongly preferred.

Experience With HealthRules Payor And HealthRules Care Manager Preferred.

Certified coder preferred.

Knowledge, Skills, And Abilities

This list contains knowledge, skills, and abilities that are typically associated with the job. It is not all-inclusive and may vary from position to position

Required technical skills include the intermediate knowledge and ability of

• Rules-based table driven-claims and eligibility administration systems.
• Implementation processes within a claims operations or product management environment.
• Medical terminology, medical coding (CPT4, ICD10, and HCPCS), provider contract concepts, and common claims processing/resolution practices.
• Ability to gather, analyze, and communicate complex requirements in a simple and easy to understand manner to both technical and non-technical staff.
• Microsoft Office Suite and Microsoft Access.
• Project tracking, testing, and requirement tools (Microsoft Project, SharePoint, JIRA).
• Business process improvement and project management.

Required working knowledge of

• PEHP standards and contract compliance.
• User department objectives, processes, interactions, and usage of administrative systems.

Must possess excellent communication skills

• Read, analyze, and interpret common technical reports, legal documents, and agreements.
• Communicate effectively with technical and non-technical staff and with members of interdisciplinary teams.
• Respond professionally to common inquiries or complaints.

Must have the ability to

• Follow written and verbal instructions.
• Prioritize work, multi-task, follow through with assignments and perform within deadlines.
• Maintain a strong attention to detail.
• Deal effectively with stress caused by workload and time deadlines.
• Work well in a team environment as well as independently.

ADMINISTRATIVE SYSTEMS ANALYST III

Minimum Qualifications

Education and Experience

High School diploma and eight (8) years of relevant managed care/health plan business analysis or system software configuration experience, or an equivalent combination of education and experience is required.

Bachelor's degree with a strong emphasis in information technology, information systems, business, data analytics, or some other related field is strongly preferred.

Experience With HealthRules Payor And HealthRules Care Manager Preferred.

Certified coder preferred.

Knowledge, Skills, And Abilities

This list contains knowledge, skills, and abilities that are typically associated with the job. It is not all-inclusive and may vary from position to position

Required technical skills include the intermediate knowledge and ability of

• Project tracking, testing, and requirement tools (Microsoft Project, SharePoint, JIRA).
• Implementation processes within an administrative systems, product management environment.
• Microsoft Office Suite.
• Rules-based table driven-claims and eligibility administration systems.
• Medical terminology, medical coding (current CPT, ICD, and HCPCS), provider contract concepts, and common claims processing/resolution practices.
• Ability to gather, analyze, and communicate complex requirements in a simple and easy to understand manner to both technical and non-technical staff.
• Clinical editing software.
• Business process improvement and project management.

Required working knowledge of

• User department objectives, processes, interactions, and usage of administrative systems.
• PEHP standards and contract compliance.

Must possess excellent communication skills

• Respond professionally to common inquiries or complaints.
• Communicate effectively with technical and non-technical staff and with members of interdisciplinary teams.
• Read, analyze, and interpret common technical reports, legal documents, and agreements.

Must have the ability to

• Maintain a strong attention to detail.
• Prioritize work, multi-task, follow through with assignments, and perform within deadlines.
• Follow written and verbal instructions.
• Deal effectively with stress caused by workload and time deadlines.
• Work well in a team environment as well as independently.