About Us

\n

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

\n

Our Core Values are:

\n\nWe serve faithfully by doing what's right with a joyful heart.\nWe never settle by constantly striving for better.\nWe are in it together by supporting one another and those we serve.\nWe make an impact by taking initiative and delivering exceptional experience.\n\n

Benefits

\n

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

\n\nEligibility on day 1 for all benefits\nDollar-for-dollar 401(k) match, up to 5%\nDebt-free tuition assistance, offering access to many no-cost and low-cost degrees, certificates and more\nImmediate access to time off benefits\n\n

At Baylor Scott & White Health, your well-being is our top priority.

\n

Note: Benefits may vary based on position type and/or level

\n

Job Summary

\n

100% Remote position

\n

The Benefit Configuration Analyst examines configuration change requests. They establish the technical scope, impact on systems, and required modifications. Accountable for designing, writing, testing, training, documenting, and implementing configurations to meet customer needs.

\n

The pay range for this position is $25.14/hour (entry level qualifications) - $42.11/hour (highly experienced).  The specific rate will depend upon the successful candidate's specific qualifications and prior experience.  

\n

\n

Essential Functions of the Role

\n\nExecute the build and implementation of benefit plan adjudication rules\nCoordinate the integration or conversion of new clients and / or products as needed\nParticipate in the development and implementation of an enterprise claim platform, providing subject matter expertise on the system configuration and usability components\nDevelop best practices and standard operational procedures for creating and configuring benefit plans\nEstablish consistency and standardization as it relates to tools and processes (deliverable templates, change management processes, business models, process flows, etc.)\nAbility to execute testing to ensure the accurate configuration of business requirement\nAnalyze larger sets claims data to evaluate patterns of billing as it relates to benefit design and configuration\nPartner with claim processors, member service and provider service to identify and resolve issues related to the plan configuration\nMaintains assigned subsystem.\nMonitors existing system functionality and makes recommendations, where appropriate, to maintain acceptable levels of performance, reliability, and end user satisfaction.\nUtilizes system development lifecycle methodology to implement system changes to production environments.\nInstalls, checks quality, and tests system configurations, software changes, and upgrades. Ensures accuracy, completeness, and compatibility of changes.\nEnsures the quality and integrity of work requests through the use of production validation and audit strategies.\nResearches complex problems to find possible solutions. Designs and implements solutions to help key business targets. This includes developing design requirements and technical specifications.\nCreates complex design documents by assessing requirements. Assesses design alternatives and chooses the best solution for business needs. Considers interdepartmental impact when recommending solutions.\nServes as an internal consultant and subject matter expert. Participates on cross-functional teams and projects. Troubleshoots inquiries and issues from other departments.\nDevelops, maintains, and disseminates internal and external configuration documentation, including status updates. Prepares procedural and customer documentation when required.\nPerform other duties as assigned\n\n

Key Success Factors

\n\nTwo years of benefit configuration experience strongly preferred (new products, authorization requirements, commercial/government/ASO lines of business). \nExperience with Health Edge's HealthRules Payer claims management software strongly preferred.\nExperience with benefit configuration & claim analysis strongly preferred.\nBroad operational managed care background preferred.\nPrevious training and documentation experience preferred.\nExceptional data, problem-solving and project management skills.\nAble to perform complex business and product requirement study.\nDemonstrates a high level of skill in data investigation and query tools like MS-Access, SQL, and MS-Excel to find root-cause issues.\nKnowledge and expertise of medical benefit policies and plan designs, claims hospital and medical processing, and adjudication with data skills.\nWorking knowledge of CPT-4, ICD-10-CM, and general medical terminology.\nExcellent relational skills, including the ability to work with all levels of personnel.\n\n

Belonging Statement

\n

We believe that all people should feel welcomed, valued and supported, and that our workforce should be reflective of the communities we serve.

QUALIFICATIONS

 EDUCATION - Bachelor's or 4 years of work experience above the minimum qualifications

EXPERIENCE 

2 Years of Experience