Configuration Quality Assurance Analyst

City/State
Doral, FL

Overview

AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Configuration Analyst in Miami and/or Gainesville, Florida. This is a hybrid position, 2 days in office and 3 days remote.

Scope of position: The Configuration Quality Assurance Analyst is directly engaged in all aspects of the Configuration Quality Assurance (QA) lifecycle, including planning, implementation, creating and executing test scripts, auditing, and reporting to assure the delivery of a high-quality product. The Quality Configuration Assurance Analyst supports integration and business process activities that utilize configuration by performing more complex technical and analytical testing, validation, and quality assurance of business requirements, including, but not limited to, performing, managing, and maintaining testing and quality assurance-related documentation and applying related industry best practices. This includes but is not limited to all benefit and provider (ancillary, hospital, and physician) configuration tasks.

Primary responsibilities include:

1. Executing the overall Configuration QA strategy.
2. Leading configuration test plans.
3. Reporting Configuration quality metrics.
4. Identifying process improvements.
5. Soliciting business input.
6. Reviewing quality trends and errors’ root causes.
7. Using collected data to develop and maintain effective, efficient, and innovative integrated departmental processes for all members of the Configuration Department.
8. Collaborating with the Configuration team on process improvement opportunities and business impacts.
9. Providing approval to deliver configuration builds to UAT, Pre-Prod, and Production.

Essential Job Functions:

• Identify, recommend, prioritize, and implement new Configuration quality features.
• Design, develop, test, and implement Configuration best practices.
• Perform testing, validation, and quality assurance of business requirements in lower environments and Production post-implementation.
• Diagnose and troubleshoot problems with existing Configurations at all levels.
• Identify, analyze, and validate recommendations for end-to-end business process and/or configuration improvements.
• Facilitate user acceptance test planning, test case specifications, test execution, peer reviews, defect management, and test status reporting.
• Follow established procedures for Configuration versioning and change management between multiple environments.
• Identify opportunities for process improvements, including the use of automated testing tools to reduce the testing life cycle.
• Apply current industry and regulatory standards for Configuration Quality.
• Prepare and maintain internal Configuration Quality Assurance documentation.
• Coordinate with vendors and trading partners during the design and implementation of third-party applications.
• Interface and collaborate with peers within and outside the department to support configuration quality assurance best practices.
• Work with IT to design, develop, and update processes for efficiency and accuracy rates for Configuration.
• Perform Configuration audits and baseline them against industry best practices.
• Monitor and report on Configuration accuracy on an ongoing basis.
• Focus on achieving departmental and organizational objectives.
• Recognize and observe all company and departmental policies and procedures.
• Provide expertise to design, develop, and maintain systems and processes for timely audit of quality control processes.
• Develop and create audit reports and quality findings to assist with monitoring and reporting to management.
• Develop and maintain a system of checks and balances for quality auditing data.
• Responsible for providing recommendations for end-to-end business process and/or configuration improvements.
• Serve as the expert in the design, development, and implementation of departmental-wide testing and audit procedures.
• Apply knowledge of configuration quality assurance best practices.
• Perform cost-benefit analyses of proposed Configuration Quality Assurance and Audit solutions.
• Conduct research into current and emerging Configuration Quality Assurance trends.
• Keep abreast of trends in Configuration Quality Assurance, coding practices, and Health Care.
• Perform additional duties as assigned by management.

Minimum Requirements:

• Bachelor's in business administration, Health Administration, or related field required.
• Masters preferred.
• Minimum 5 years of experience in a Systems Configuration, Claims, Benefits, or other Operations department.
• Minimum 2 years of experience in Quality Assurance in the Healthcare industry.
• Understanding of the Standards for the Professional Practice of Internal Auditing.
• Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or related coding certification preferred.
• An equivalent combination of education and experience may be considered.

Preferred Requirements:

• Advanced claims experience with major claims processing system.
• Strong process/workflow development & execution skills required.
• Advanced skill level in Microsoft Office Products (Excel, Word, PowerPoint, Visio), Business Objects, or SQL.
• Strong working knowledge of claims adjudication, benefits administration, and provider/institutional contractual interpretation.
• In-depth knowledge of codes, e.g., CPT, ICD-9, HCPCS, DRG, and ASC grouping.
• Ability to work on multiple projects/jobs simultaneously with maximum efficiency.
• Strong analytical/quantitative and critical thinking skills.
• Excellent interpersonal, written, and oral skills required.
• Strong ability to influence change.
• Ability to work with high-level concepts and in ambiguous situations.
• Excellent organizational skills.
• Project management experience preferred.

Our Benefits: As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including:

• Medical, Dental, and Vision Insurance.
• Paid Annual Leave, Sick Leave.
• Flexible Spending Accounts.
• Retirement funds with matching contribution.
• Supplemental insurance policies, including legal, Life Insurance and AD&D among others.
• Work Perks program including discounted movie and theme park tickets.
• Opportunities for further advancement within our organization.

Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!