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GENERAL DESCRIPTION OF POSITION

The Configuration Data Analyst is responsible for system configuration, implementations and conversions of SCFHP’s core systems. This position is responsible for the accurate interpretation and associated configuration of regulatory federal and state guidelines. along with business contractual agreements impacting benefits, contracts, millions of dollars in claims payment, case management, and/or grievance and appeals within core systems. The Configuration Data Analyst must have the ability to meet with internal and external business units and peers to gather requirements, independently analyze and mine data, draw sound conclusions, configure, test and implement the data structures that support SCFHP’s managed care information system (s) required to meet business needs, regulatory compliance, and vendor contractual obligations.

REQUIREMENTS – Required (R) Desired (D)

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

Bachelor’s Degree in Healthcare, Information Systems, or related field, or equivalent experience, training or coursework. (D) Experience in healthcare (D) Minimum three years of experience performing the above responsibilities or a minimum of 5 years Claims processing or application vendor experience in a managed care environment. Other additional qualifications may be used to substitute for a required experience. (D) Ability to work in a group environment and clearly communicate discussion points as needed. (R) Ability to understand technical requirements and configuration logic to ensure systems are properly configured to meet business needs. (R) Ability to meet deadlines, multi-task, troubleshoot, and problem-solve. (R) Must be able to utilize analytical skills to conceptualize and envision impact of changes, and recommend resolutions for business or system issues and gaps. (R) Ability to audit implemented changes to detect and resolve discrepancies to ensure work is accurate and precise. (R) General understanding of health care data sets such ICD9/10, CPT/HCPCs, provider contracts and benefits, authorizations, etc. (R) Knowledge of relational databases such as SQL and Microsoft Access. (D) Knowledge of CMS and DHCS pricing and benefit structure (D) Claims processing and Claims Management System configuration experience. (D) Ability to read and interpret technical procedures, government regulations and guidelines, and various contract provisions, and apply the knowledge. (R)

Santa Clara Family Health Plan (SCFHP) is a local, community-based health plan dedicated to improving the health and well-being of the residents of Santa Clara County. Working in partnership with providers and community organizations, we serve our neighbors through our Medi-Cal and SCFHP DualConnect (HMO D-SNP) health care plans.