Reports To: Manager, AMISYS Configuration & Consulting
Purpose: Interpret business objectives to analyze and configure AMISYS® to calculate appropriate benefit determinations and appropriate health claim reimbursement for multiple business lines. Creates and maintains system configuration, tables, and codes which translate ConnectiCare’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, maintains, and is responsible for the integrity of all AMISYS® configuration to support premium billing and collection functions, including but not limited to premium collection, employer group administration, membership structures, correspondence, and employer specific benefits.
2. Creates, maintains, and is responsible for the integrity of all AMISYS® configuration to support claim adjudication, including but not limited to benefits determination, accumulator/counter, GMIS, Liability/Recovery, correspondence, and coding protocols.
3. Creates, maintains, and is responsible for the integrity of all AMISYS® configuration to support provider reimbursement, including but not limited to provider contract configuration, capitation reimbursement, and fee schedule administration.
4. Creates, maintains, and is responsible for the integrity of all AMISYS® configuration to support Finance functions, including but not limited to banking, claims payable, claims funding, risk structure maintenance, general ledger, and non-monthly capitation rate maintenance.
5. Creates, maintains, and is responsible for the integrity of all AMISYS® configuration to support Medical Management functions, including but not limited to authorization requirements, referral processing, correspondence, and claims matching criteria.
6. Creates, maintains, and is responsible for the integrity of all AMISYS® configuration to support general processing and data maintenance rules, including but not limited to address, switches, and global settings.
7. Mentors Business Analysts, utilizing methods designed for growth of Business Analysts to those knowledge components necessary to grow into the AMISYS® Consultant role.
8. Recommends system solutions and alternatives that meet business objectives, resolve system deficiencies and, and ensure efficient functionality.
9. Unit tests system configuration changes while adhering to the monthly configuration release schedule, working with appropriate Business Analyst team member to ensure testing scope of individual configuration changes.
10. Develops and maintains a comprehensive understanding of AMISYS® and related ConnectiCare business applications. Remains abreast of new AMISYS® release functionality and participates in the testing of AMISYS release upgrades.
11. Performs other related projects and duties as assigned.
TECHNICAL KNOWLEDGE, EXPERIENCE, AND SKILL REQUIREMENTS:
1. Bachelor's Degree or an equivalent combination of education and experience in a health care environment performing system configuration or analysis/support of claim adjudication.
2. At least 3 years of previous experience in the administration of health care benefits, administration policies, or provider reimbursement policies and mechanisms.
3. Knowledge of medical terminology, coding protocols, provider reimbursement, and benefit structures required.
4. Familiarity with managed care business concepts required (e.g. administration, benefits administration, or medical reimbursement).
5. Excellent oral and written communication and interpersonal skills required.
6. Strong project management skills required with the ability to multi-task many projects simultaneously.
1. Member and Customer Focus: Recognizes that members and customers (internal & external) are the driving force behind every business activity. Continuously makes an effort to exceed the expectations of members and customers.
2. Quality Orientation: Assumes responsibility for providing the highest level of quality to members and customers.
3. Innovation: The ability to see opportunities for change, to capitalize on them and implement them when appropriate for the benefit of ConnectiCare.
4. Communication: The ability to communicate with clarity both orally and in writing.
5. Teamwork: Demonstrates enthusiasm for the mission of ConnectiCare and inspires the same in others.
6. Results Orientation: The ability to break a complex problem down into its component parts and arrive at the appropriate solution in a timely fashion.
7. Change Mastery: Embraces change.
8. Learning Orientation: Assumes responsibility for personal and professional development.
ConnectiCare is an equal opportunity employer. M/F/D/V
ConnectiCare - 16 months ago
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