HealthEdge Configuration Analyst

HealthEdge Configuration Analyst

Contract-to-hire

The HealthEdge Configuration Analyst will work as part of a multidisciplinary consulting team to implement the HealthRules Payor (HRP) platform for a health insurance payer client. This role focuses on configuring the HRP platform, collaborating with cross-functional teams to understand business requirements, translating these requirements into system configurations, and ensuring the platform operates efficiently and aligns with the client’s business processes.

Responsibilities

Configuration Management:

Configure and customize the HRP platform, including benefit plans, provider networks, and business rules, to meet client requirements.

Ensure compliance with payer-specific guidelines, regulatory requirements, and organizational standards.

Requirements Analysis:

Collaborate with business analysts, project managers, and client stakeholders to gather and analyze business requirements.

Translate requirements into technical specifications for system configuration.

Testing and Validation:

Develop and execute test plans to validate system configurations and ensure accuracy in claim adjudication, member management, and provider integration.

Troubleshoot and resolve issues identified during testing or post-implementation.

Documentation and Training:

Document configuration changes, processes, and workflows to ensure traceability and facilitate knowledge transfer.

Provide training and support to end users and internal teams on the configured HRP platform.

Collaboration and Support:

Serve as a liaison between the client and technical teams to address configuration needs and system improvements.

Assist in post-implementation support and enhancements as required.

Requirements

Strong understanding of HealthEdge HealthRules Payor platform architecture and components.

Experience with claims processing, benefits configuration, and provider network setup.

Familiarity with SQL and relational databases for querying and data validation.

In-depth understanding of healthcare payer operations, including claims adjudication, member management, and provider contracting.

Familiarity with CMS guidelines, HIPAA compliance, and other regulatory standards.

Excellent analytical and problem-solving skills.

Strong written and verbal communication abilities.

Effective collaboration with multidisciplinary teams in a consulting environment.

Previous experience working in consulting roles for healthcare payers.

Exposure to agile project management methodologies.

Education and Experience

Bachelor’s degree in Computer Science, Information Systems, Healthcare Administration, or a related field.

3+ years of experience configuring and implementing healthcare payer platforms, preferably HealthRules Payor (HRP).