Offers “Accenture”

Expires soon Accenture

HealthRules Configuration Sr. Analyst

  • Internship
  • Southwest, USA

Job description



Accenture is a leading global professional services company, providing a broad range of services and solutions in strategy, consulting, digital, technology and operations. Combining unmatched experience and specialized skills across more than 40 industries and all business functions – underpinned by the world's largest delivery network – Accenture works at the intersection of business and technology to help clients improve their performance and create sustainable value for their stakeholders. With approximately 425,000 people serving clients in more than 120 countries, Accenture drives innovation to improve the way the world works and lives. Visit us at http://www.accenture.com/ .

People in our Client Delivery & Operations career track drive delivery and capability excellence through the design, development and/or delivery of a solution, service, capability or offering. They grow into delivery-focused roles, and can progress within their current role, laterally or upward.

Job description:
Perform system configuration of benefits and provider contracts into the HealthEdge's HealthRules system. Responsibilities will include creating functional design where benefit plan and provider contract specifications are interpreted into the proper business rules and components for configuration in the system to drive system functionality. This role will also act as liaison with Sales, Underwriting, Product Development, Medical Policy, Claims, Provider contracting, Networking and Relations business resources.
Primary responsibilities:

· Translate benefit plans and provider contract terms and details into system contract configuration parameters
· Configure fee schedules and supplier contracts
· Configure benefit plans, service categories and benefit and network components to support enrollment and claims processing
· Ensure HealthRules configuration takes into consideration reporting requirements and are compatible with other internal systems in the enterprise environment
· Configure, test and document HealthRules Payor software
· Develop, document and execute test plans by evaluating claim results for configuration testing

Desired profile



Qualifications :

Basic qualifications:
·  Minimum 2 years' experience functional business experience in the health payer industry, specifically in benefits configuration/coding, provider enrollment in a health plan, provider reimbursement, supplier contracts including capitation arrangements and pricing rules
·  Minimum 2 years' experience with Medicare Advantage and custom fee schedules, interpreting professional, facility and ancillary provider contracts, interpreting product design or benefit summaries into service categories, benefit tiers, riders and cost share elements
·  Minimum 2 years' experience with State and federal mandates
Preferred skills:
·  6 months of experience HealthEdge HealthRules software
·  3 years configuration experience on similar payer systems (e.g. Facets)
·  Experience in claims research, adjustments or appeals
·  Experience configuring Optum's EasyGroup PPS and CES products
·  Experience working on a full life cycle project adhering to Software Development Life Cycle (SDLC)
·  Experience working in an Agile development environment
·  Proficient in Healthcare policies and Health Plan terminology and coding
Professional requirements:
·  Excellent interpersonal and communication skills
·  Strong analytical and problem solving skills
Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States and with Accenture.

Accenture is an EEO and Affirmative Action Employer of Females/Minorities/Veterans/Individuals with Disabilities. Equal Employment Opportunity: All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.

Accenture is committed to providing veteran employment opportunities to our service men and women.

Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.

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