Benefit Configuration Analyst - Hybrid
Company: Parkland Health and Hospital System (PHHS)
Location: Dallas
Posted on: March 13, 2025
Job Description:
Interested in a career with both meaning and growth? Whether
your abilities are in direct patient care or one of the many other
areas of healthcare administration and support, everyone at
Parkland works together to fulfill our mission: the health and
well-being of individuals and communities entrusted to our care. By
joining Parkland, you become part of a diverse healthcare legacy
that's served our community for more than 125 years. Put your
skills to work with us, seek opportunities to learn and join a
talented team where patient care is more than a job. It's our
passion.Primary PurposeThe Analyst - Benefit Configuration (QNXT)
ensures the accurate and timely setup and maintenance of benefits,
contracts, and other critical configurations in the QNXT system.
This role supports the health plan's operational and regulatory
requirements by aligning system configurations with business rules
and compliance standards.Minimum SpecificationsEducation
- Associate degree in business administration or related
discipline required.
- Bachelor's degree preferred.Experience
- Three years of QNXT or other claims system configuration
experience required.
- Experience with QNXT preferred.Skills or Special Abilities
- Excellent verbal and written communication skills including the
ability to communicate effectively and professionally across
disciplines. Ability to communicate complex information in
understandable terms.
- Strong interpersonal and conflict resolution skills with the
ability to establish and maintain effective working relationships
across and beyond the organization.
- Excellent analytical and problem-solving skills.
- In-depth knowledge of QNXT system configuration modules,
including benefits, contracting, and fee schedule setup.
- Ability to interpret and implement business rules within claims
system configurations.
- Strong time management and organizational skills with the
ability to manage multiple demands and respond to rapidly changing
priorities.
- Ability to write clearly and succinctly with a high level of
attention to detail.
- Proficient computer and Microsoft Office skills. Ability to
learn new software programs.
- Knowledge of Texas Medicaid, National Committee for Quality
Assurance (NCQA), the Uniformed Managed Care Contract, and the
Uniform Managed Care Manual.ResponsibilitiesOperations
- Accurately configure and maintain benefits, contracts, prior
authorizations, and fee schedules in QNXT to meet business and
compliance needs.
- Accurately interprets specific state and/or federal benefits,
contracts as well as additional business requirements and
converting these terms to configuration parameters.
- Work closely with the Configuration Manager to implement system
updates, resolve challenges, and ensure smooth operational
processes.
- Partner with teams such as Claims, IT, Provider Data
Management, and Operations to gather requirements, troubleshoot
issues, optimize workflows, maintain system integrity, validate
configurations, and implement process improvements.
- Document configuration changes and create user-friendly
documentation for future reference.Quality
- Integrate health literacy principles into all communication
including Members and Providers.
- Support strategies that meet clinical, quality and network
improvement goals.
- Promote the use of Health Information Technology to support and
monitor the effectiveness of health and social interventions and
make data-driven recommendations as needed.
- For staff in clinical roles, foster collaborative relationships
with members and/or providers to promote and support evidence-based
practices and care coordination.
- Troubleshoot and resolve configuration-related issues in
collaboration with internal teams.
- Perform thorough testing and validation of configurations to
support UAT and ensure accurate claims adjudication.
- Identify risks related to configuration and propose solutions
to mitigate errors.
- Monitor system performance and recommend enhancements to
improve efficiency and accuracy in claims processing.
- Stay current on industry trends, Medicaid/CHIP policy updates,
and QNXT system enhancements to implement best
practices.Regulatory
- Ensures work is carried out in compliance with regulatory
and/or accreditation standards as well as contractual
requirements.
- Conduct regular audits to ensure system configurations align
with operational requirements and regulatory standards.
- Ensure compliance with Texas Medicaid/CHIP regulations, NCQA
standards, and organizational policies.Professional
Accountability
- Promotes and supports a culturally welcoming and inclusive work
environment.
- Acts with the highest integrity and ethical standards while
adhering to Parkland's Mission, Vision, and Values.
- Adheres to organizational policies, procedures, and
guidelines.
- Completes assigned training, self-appraisal, and annual health
requirements timely.
- Adheres to hybrid work schedule requirements.
- Attends required meetings and town halls.
- Recognizes and communicates ethical and legal concerns through
the established channels of communication.
- Demonstrates accountability and responsibility by independently
completing work, including projects and assignments on time, and
providing timely responses to requests for information.
- Maintains confidentiality at all times.
- Performs other work as requested that is reasonably related to
the employee's position, qualifications, and competencies.Job
Accountabilities
- Identifies ways to improve work processes and improve customer
satisfaction. Makes recommendations to supervisor, implements, and
monitors results as appropriate in support of the overall goals of
PCHP.
- Stays abreast of the latest developments, advancements, and
trends in the field by attending seminars/workshops, reading
professional journals, actively participating in professional
organizations, and/or maintaining certification or licensure.
Integrates knowledge gained into current work practices.
- Maintains knowledge of applicable rules, regulations, policies,
laws, and guidelines that impact the area. Develops effective
internal controls designed to promote adherence with applicable
laws, accreditation agency requirements, and customer requirements.
Seeks advice and guidance as needed to ensure proper
understanding.Parkland Health and Hospital System prohibits
discrimination based on age (40 or over), race, color, religion,
sex (including pregnancy), sexual orientation, gender identity,
gender expression, genetic information, disability, national
origin, marital status, political belief, or veteran status.As part
of our commitment to our patients and employees' wellness, Parkland
Health is a tobacco and smoke-free campus.
Keywords: Parkland Health and Hospital System (PHHS), Dallas , Benefit Configuration Analyst - Hybrid, Professions , Dallas, Texas
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