Job Summary

The Quality Configuration Assurance Analyst III is responsible for the more complex technical and analytical work related to the testing, validation, and quality assurance of business requirements for and the configuration of the L.A. Care Health Plan Core System (i.e., QNXT) and the related surround systems, applications, and database (e.g., Clinical CareAdvance (CCA), Process Communication Tracking (PCT), etc.). The Quality Configuration Assurance Analyst III collaborates closely with peers and management within the department as well as throughout the organization to facilitate the timely, accurate quality assurance of the systems configuration; in-depth analysis of major factors, root causes, etc. that impact member access to care, claims payments, etc.; and assessment and roll-out of key measures to facilitate improvement, where warranted. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.

Duties

Identify, develop, and recommend new and/or enhanced testing specifications and related documentation. Serve as a subject matter expert for the quality assurance of the configuration of the core and surround systems. Perform the most complex quality audits of the systems configuration. Conduct thorough, in-depth root cause analysis to help identify issues and provide well thought-out recommendations for proposed business process and systems configuration improvements, where warranted.

Interface and collaborate with peers within and outside of the department and the organization to support quality assurance best practices, business process and systems configuration improvements, product enhancements, compliance with established turnaround times and service levels, etc.

Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.

Perform other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 5 years of experience in Systems Configuration; Claims and Health Services/Population Health department.

Advanced knowledge of and experience in health plan quality assurance (especially related to claims, health services/population health as well as appeals and grievances systems, applications, etc.)

Knowledge of and experience with utilizing SDLC and related change management methodologies, standards and best practices.

Preferred:

At least 5 years of experience working with a California Medi-Cal managed care plan or Commercial health plan, medical group, or management services organization.

Skills

Required:
Advanced understanding of managed care operations (including but not limited to, claims processing, population health, appeals and grievances, etc.) and the systems that support these operations.

Knowledge of Systems Development Life Cycle (SDLC) procedures in planning the quality assurance (i.e., use of rigorous documentation, testing, and quality assurance protocols pre- and post-deployment).

Strong analytical, organization, and time management skills.

Able to meet strict, tight deadlines with a high level of accuracy.

Able to prioritize multiple tasks.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information