Health Plan Business (Facets) Configuration Analyst - Health Alliance Plan
Henry Ford Health Troy, Michigan, United States
Hospitals and Health Care · 10,001+ employees
About the role
This role manages system configuration, ensures compliance, and drives quality for health plan applications. The analyst serves as a system expert, coordinating with IT and business departments to resolve issues and implement enhancements.
What they look for
Requirements
Candidates must have a bachelor's degree in computer science or business administration and at least six years of relevant healthcare or claims processing experience. Proficiency in Facets configuration and strong analytical skills are essential for this position.
Full description
Company Description
Health Alliance Plan by Henry Ford Health is a Michigan-based, nonprofit health plan that provides health coverage to individuals, companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
Job Description
GENERAL SUMMARY:
This role sits at the intersection of business, IT, and operations—owning system configuration, ensuring compliance, driving quality, and enabling efficient issue resolution and system enhancements.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Initiate the analysis of, and ensure adequate evaluation of, system impacts. Serve as the system expert for customer bases and IT departments.
- Prepare recommendations for enhancements to system applications/vendors.
- Coordinate BCT efforts and customer needs to ensure expeditious response and resolution of system problems/issues.
- Perform ongoing quality review checks to ensure a superior product for on-going production support.
- Responsible for the performance of the application software based on customer requirements and ensuring that systems conform to Government Programs, and Regulatory Agency Standards.
- Assist in the analysis and testing of new Facets releases while identifying the impact to interfaces for externally developed packages.
- Participate in corporate project meetings to disseminate the customer's needs and priorities to corresponding team leadership.
- Interact with other departments and divisions within Health Alliance Plan and Henry Ford Health to establish consistent interpretation of various policies and procedures throughout the system.
- Perform other related duties as assigned.
Qualifications
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor’s degree in computer science or business administration.
- Related and relevant experience may be considered in lieu of academic requirements. Related experience is defined as six (6) years’ experience in Health Care related business and/or claims processing system configuration.
- Two (2) years of claims processing system configuration experience or demonstrated proficiency through relevant Health Alliance Plan specific business experience.
Preferred:
- Five (5) years of Health Care related business experience preferred.
- Knowledge of Facets claims processing with the ability to troubleshoot.
- Ability to work at a fast pace in a constantly changing environment.
- Ability to Interpret Member and Group contracts and translate into Benefit configuration.
- Analytical thinking required for troubleshooting configuration-related defects
- Experience developing Service IDs, Supplemental Mapping, Service Rules, Variable Components, Product Component Configuration in Facets.
- Knowledge of Facets Group, billing, class/plan configuration in Facets
- Experience in open enrollment processes preferred (new Plan/Product creation, passive enrollment, Mass member transfer etc.)
- Knowledge of claim processing, accumulators, provider reimbursement, member eligibility and authorizations
- SQL experience preferred (Oracle and SQL Server)
- Certified Medical Coder preferred
- Demonstrated ability to research, analyze, design, plan, organize, coordinate, implement, and perform necessary follow-up and closure procedures for system related projects.
- Demonstrated ability to collect and prepare data for written/oral presentations.
- Demonstrated ability to communicate effectively.
- Ability to interact with outside sources and maintain professional contacts.
- Excellent written and verbal communication skills are essential.
- Must be able to work effectively with persons of varying position levels and diverse interests.
- Understanding of healthcare industry and managed care concepts.
- Knowledge of a table-driven claims processing system.
- Knowledge of Windows, Microsoft Excel and Word, Query Tools (COGNOS, etc.) and Implementation/Administration of Packaged Claims Processing Applications.
- A high level of human relations skills.
- Ability to adapt to a constantly changing environment.
