About this role
At RAM Health, our mission is to simplify the complexities of healthcare administration through innovative, technology-driven solutions. With a focus on changing the industry one plan at a time, we drive continuous innovation to help government-sponsored health plans improve performance and quality while reducing costs.
RAM Health - Health plan administration, simplified.
The Configuration Specialist will be responsible for creating and maintaining a variety of system configurations to ensure compliance with client and regulatory business rules. This requires the ability to work closely with internal and external stakeholders to interpret business requirements, design solutions and complete changes within the system. The role also requires coordinating with industry third party software to ensure all rules are functioning appropriately to achieve desired results. In this role, the specialist must have excellent problem-solving skills, along with keen attention to detail and outstanding written and oral communication abilities.
Responsibilities:
• Review and translate business requirements into configurable components
• Design solution that drive highest levels of automated and accurate outcomes
• Develop, maintain and execute configuration changes including but not limited to benefits, pricing, member products/plans, premium billing, letters, other business rules and workflow
• Work with testers, operations and the client to ensure results match requirements
• Continuous validation of configuration environment to validate synchronization with current releases and coordinate environment updates as needed
• Document configuration changes, provide support in troubleshooting issues, track progress of completion and deployment of changes within expected timelines
Requirements:
• 2-6 years in healthcare industry experience working in the payer segment in Medicare Advantage, Managed Medicaid, or working with other healthcare service providers.
• Experience in setting up and maintaining healthcare payor system configuration is required. Experience in commercial lines of business is a plus.
• Candidate must have knowledge of Medicare rules and the ability to translate into business outcomes.
• Strong SQL experience, MS Excel, MS Access. Exceptional interpersonal, listening, written and oral communication abilities a must.
• Attention to detail and the ability to work under time constraints are also required. Experience with Healthcare EDI files and knowledge of Medicaid rules are a plus.
• A bachelor's degree or equivalent is preferred.
This position offers an excellent benefit package that includes medical, dental, vision, 401(k) with match, life insurance, LTD, 5 weeks vacation, and paid holidays.
Compliance: All employees shall comply with company policies, including those related to security and privacy, as well as with applicable laws and regulations such as the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act, and other relevant federal and state regulations.
Data Protection: Employees are responsible for safeguarding protected health information (PHI) and personally identifiable information (PII) in accordance with company policies and HIPAA regulations. This includes ensuring that all data is accessed, processed, stored, and transmitted securely.
Note: This job description is intended to convey information essential to understanding the scope of the position and is not an exhaustive list of efforts, duties, responsibilities, or working conditions associated with it. Duties, responsibilities, and activities may change at any time with or without notice.
$70,000 - $95,000