Note: The job is a remote job and is open to candidates in USA. SCAN is a nonprofit health organization focused on improving care for older adults. The Configuration Analyst II supports the implementation, maintenance, testing, and governance of benefit configuration and Prior Authorization and Pre-Determination code sets across claims, utilization management, and related systems. The role also performs data analysis, troubleshooting, reporting, documentation, and process improvement while collaborating with internal teams, providers, vendors, and delegated entities.
Responsibilities
- Maintains PA and PD code sets across claims, utilization management, and related operational systems
- Supports benefit configuration and prior authorization activities, including configuration, testing, validation, deployment, and post implementation review
- Serves as a technical liaison for PA and PD configuration activities with internal teams, delegated entities, providers, and vendors
- Troubleshoots and resolves benefits and authorization-related configuration issues, technical inquiries, and system problems impacting operational workflows
- Supports Annual Enrollment Period (AEP) readiness by completing assigned benefit configuration activities, validating configuration accuracy, and meeting established implementation timelines
- Analyzes data to identify trends, risks, process improvement opportunities, and operational or financial impacts
- Supports continuous improvement initiatives by enhancing workflows, reporting capabilities, data quality, system functionality, and operational efficiency
- Creates and maintains procedures, workflow documentation, training materials, and other resources supporting PA and PD list operations
- Maintains knowledge of healthcare coding standards, authorization processes, CMS regulations, healthcare technology, and related best practices
- We seek Rebels who are curious about AI and its power to transform how we operate and serve our members
- Actively support the achievement of SCAN’s Vision and Goals
- Other duties as assigned
Skills
- Bachelor's Degree or equivalent experience in Healthcare Administration, Health Information Management, Information Systems, Data Analytics, Business, Computer Science, or related field
- 2 or more years of experience in healthcare systems, operations, analytics, medical coding, utilization management, or related technical functions
- 2 or more years of experience with reporting, data analysis, SQL, or healthcare-related data
- Experience working with healthcare coding systems, code set maintenance, or authorization-related processes
- Knowledge of healthcare coding systems, including CPT®, HCPCS, and related code sets
- Understanding of healthcare claims processing, utilization management, authorization workflows, and healthcare operations
- Strong analytical and problem-solving skills, including data interpretation, issue identification, root cause analysis, and solution development
- Proficiency in data analysis, reporting, performance measurement methodologies, SQL, reporting tools, and business intelligence platforms preferred
- QNXT experience is required
- Proficiency with Microsoft Office Suite and related business productivity applications
- Excellent written and verbal communication skills with the ability to explain technical concepts to technical and non-technical audiences
- Strong organizational skills, attention to detail, and ability to manage multiple priorities and deadlines
- Demonstrated ability to work independently while collaborating across multidisciplinary teams
- Commitment to accuracy, quality, compliance, continuous improvement, and standard office-based work activities, including computer and office equipment use for extended periods
- Knowledge of CMS regulations and Medicare Advantage and Medicaid program requirements preferred
- Experience managing Prior Authorization or Pre-Determination Lists
- Experience working with Medicare Advantage and/or Medicaid managed care programs
- Experience supporting healthcare claims, utilization management, or medical policy operations
- Experience with business intelligence tools such as Power BI
- Familiarity with healthcare vendor platforms such as MHK, ikaSystems, CareAxis, or similar applications
- Experience utilizing AI-enabled analytical tools and automation technologies
- Coursework or training in healthcare analytics, healthcare informatics, business intelligence, or database management
- Certification or coursework in SQL and Power BI
- Certification in healthcare analytics, data visualization, business intelligence, or related technical discipline
Benefits
- Work Mode: Mostly Remote
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
- Excellent 401(k) Retirement Saving Plan with employer match and contribution
- Robust employee recognition program
- Tuition reimbursement
Company Overview
Company H1B Sponsorship