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Evolent Health Sr. Analyst, Configuration - Provider Contracts in Des Moines, Iowa

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. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their 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.

Why We’re Worth the Application:

  • We continue to grow year over year.

  • Recognized as a leader in driving important diversity, equity, and inclusion (DE&I) efforts (https://www.evolenthealth.com/diversity) .

  • Achieved a 100% score two years in a row on the Human Rights Campaign's Corporate Equality Index making us a best place to work for LGBTQ+ equality.

  • Named to Parity.org’s 2020 list of the best companies for women to advance (https://www.evolenthealth.com/about-us/press-releases/8579/evolent-health-named-to-parity.org%E2%80%99s-best-companies-for-women-to-advance-list-2021) .

  • Continued to prioritize the employee experience and achieved an 87% overall engagement score on our last employee survey.

  • Published an annual DE&I report (https://dev.evolenthealth.com/sites/default/files-public/Evolent%20Health%202020%20DE%26I%20Annual%20Report.pdf) to share our progress on how we’re building an equitable workplace.

What You’ll Be Doing:

Sr Analyst, Configuration (Provider Contracts)

Who You’ll Be Working With:

  • EVH Operational Teams

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):

  • 5+ years of experience in translating business requirements including Systems Analysis, Configuration Analysis, Design, Documentation, and Development & Testing

  • 5+ years of experience in claim adjudication platforms configuration across multiple - for example, Claims Processing and queues, Benefit Configuration, Pricing

  • 5+ years in contract interpretation of complex custom contracts and pricing methodology

  • Ability to work collaboratively on teams that include all levels of the 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-orientated

  • 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 plugin 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.

Technical Requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. 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 committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.

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.

Compensation Range: The minimum salary for this position is $80000, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.

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