Analyst, Configuration Information Management - Directed Payment Program

Job description

JOB DESCRIPTION: Provides analyst ‑ level support for Configuration Information Management (CIM) activities, including Directed Payment Program (DPP) and Atlis pricing oversight, ensuring accurate and timely implementation and maintenance of configuration data within claims and operational systems. Responsible for analyzing state and federal requirements, provider contracts, benefits, authorizations, and fee schedules into system configuration parameters. Ensures synchronization across systems, validates configuration accuracy, and supports claims issue resolution to maintain compliance with business, regulatory, and system requirements. Essential Job Duties: - Oversight of configuration and maintenance of benefit plans, provider contracts, fee schedules, DPP rate tables, Atlis pricing logic, and supporting system tables within claims platforms (e.g., QNXT, Networx). - Analyze and interpret state and federal requirements (Medicaid, Medicare, Marketplace), including Directed Payment Program rules and alternate pricing methodologies (Atlis), and convert these requirements into system configuration parameters. - Translate HHSC/CMS guidance, provider contract language, rate exhibits in...