Analyst, Configuration

Posted on Indeed on May 28, 2021

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving power that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign's Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

  • Collaborate with business and technical teammates to resolve client production issues
  • Participate in problem solving of Health Plan benefit, provider, pricing, reporting, operational and system issues
  • Perform a variety of tasks related to the resolution of production support issues based on client configurations with the core administrative system
  • Potential to rotate through configuration support functions across key system areas and lines of business with the ability to develop subject matter expertise
  • Support the work to troubleshoot and resolve claims issues introduced by user, configuration, system or reporting errors, working multiple issues simultaneously
  • Support activities to update configuration within the core claims processing system, typically within the areas of Provider, Pricing or Benefit Plan/Adjudication Rules. Potential responsibilities include and may vary by system area of assignment:
  • Update credentialing variables and demographics (credentialed and non-credentialed providers), contract or fee schedule assignment and network affiliation
  • Update group/benefit configuration including benefit plans (coinsurance, deductible, copay, out of pocket) and benefit plan rules
  • Support fee schedule changes including terms, affiliations, and contract maintenance
  • Updates to general system configuration such as workflow, dictionary/master file updates (research, set up and maintenance of reference values (diagnosis codes, procedure codes, 835 CARC/RARC and other medical codes) and global settings, as necessary
  • Collaborate across IT and Operational departments to define and develop necessary technology or business processes to support process improvement initiatives

The Experience You’ll Need (Required):

  • Education Requirements: Bachelor’s Degree or equivalent work experience
  • Ability to work collaboratively on team that includes all levels of organization and Health Plan
  • Ability to communicate effectively yet concisely in both an oral and written manner
  • Analytical Skills necessary to independently discover and outline systems related issues
  • Ability to support projects and recommend/implement process for project completion
  • Understanding of logic of standard medical coding manuals (i.e. CPT, ICD-10, HCPCS, etc.) and national billing guidelines (NUBC, NUCC), certified coder a plus
  • Knowledge of medical claims adjudication and editing

Finishing Touches (Preferred):

  • Detail oriented
  • Beginner skill level of Microsoft Excel required, Intermediate skill level a plus
  • EDI X12 835, 837I & 837P knowledge a plus
  • Prior experience with Facets/RIMS, CSC, DST or a rules-based system a plus
  • Database table structure knowledge and SQL query writing capability a plus

Technical requirements:

During the current pandemic Evolent employees are working remotely from home. As such we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

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