APPLICATION ANALYST - Provider Relations in San Diego, CA at Scripps Health Plan Services -4S Ranch

Date Posted: 7/19/2018

Job Snapshot

Job Description

Under general direction, participates on integrated teams to troubleshoot problems on Scrape niche systems. Designs, builds and tests system configuration. Translates business requirements into technical solutions. Conducts quality reviews of system builds. May maintain databases and create user reports.
Will perform configuration of professional and institutional vendors within the Epic Tapestry module; including associating vendors with providers, and places of service.  Analyzing workflows and processes supporting provider configuration, to ensure accuracy of utilization management, provider steering, and claim adjudication.  Develops processes for validation, analysis, and QA of vendor, provider and contract configuration.  Understanding of the types of provider contracting arrangements and data elements that need to be configured in Epic Tapestry module to support managed care operations including detailed knowledge and understanding of the Tapestry Claims processing system rules relative to claims payment.  Performs problem resolution of configuration issues received via email, fax, returned mail and other sources including resolution of Customer Relationship Management (CRM) that are for provider, vendor and place of service configuration

Job Requirements

Required Education/Experience/Specialized Skills: Excellent critical and analytical thinking and excellent customer service skills. Exhibit excellent written and verbal communication skills. Good organizational and project management skills. Business acumen in functional area.

Preferred Education/Experience/Specialized Skills/Certification: Has led small projects or technical activities.

Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.