Provider Data Mgmt. Configuration Analyst - Hybrid
Company: Parkland Health and Hospital System (PHHS)
Location: Dallas
Posted on: March 17, 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 PurposeParkland Community Health Plan's (PCHP's)
Provider Data Management Configuration Analyst is responsible for
configuring and maintaining provider data in the claims systems to
ensure accurate claims adjudication, accurate provider data in the
PCHP provider directory, and compliance with health plan
policies.Minimum SpecificationsEducation
- Bachelor's degree in Information Systems, Healthcare
Administration, or a related fieldExperience
- Three years of experience in provider data configuration,
claims systems, or health plan operations.
- Experience with QNXT or similar systems required.Equivalent
Education and/or Experience
- May have an equivalent combination of education and/or
experience in lieu of specific education and/or experience as
stated above.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.
- Proficiency in data analysis and testing methodologies, such as
Excel or SQL
- Strong technical knowledge of healthcare configuration systems
(e.g., QNXT).
- 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.Responsibilities Operations
- Analyze, configure, and maintain provider data to support
operational and business requirements.
- Supports provider contract implementation in QNXT and other
integrated platforms / systems.
- Perform unit testing, validation, and troubleshooting of
configuration updates to ensure accurate claims adjudication.
- Collaborate with Provider Network and Contracting team to
implement provider agreements.
- Support development of workflows of provider data configuration
processes.
- Maintain documentation of configuration rules, updates, and
procedures. Quality
- Monitor system performance and recommend improvements to
optimize configuration processes.
- Research and resolve provider-related configuration issues,
including claims rejections or adjudication errors.
- Provide technical support and expertise to resolve provider
data-related issues within the QNXT system.
- 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.Regulatory
- Ensures work is carried out in compliance with regulatory
and/or accreditation standards as well as contractual
requirements.
- Assist in preparation and submission of regulatory files,
ensuring system configurations meet compliance requirements.
- Ensure that all configurations and processes comply with
federal, state, and industry regulations, including Texas Medicaid
standards.
- Stay updated on regulatory changes and implement necessary
adjustments to system configurations. 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.Required
Keywords: Parkland Health and Hospital System (PHHS), Dallas , Provider Data Mgmt. Configuration Analyst - Hybrid, Professions , Dallas, Texas
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