The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
This position is remote eligible; candidates MUST reside in California.
What You Will Be Doing:
Under general supervision, responsible for ensuring that QNXT is designed, configured, tested and deployed following HPSJ policies, procedures, and standards.
- Reviews moderately complex application issues and incidents and confirms business requirements.
- Analyzes issues and incidents to determine root cause and documents.
- Develops and documents solution and submits for review; builds and documents the approved option in the test environment.
- Develops and documents test plans and tests according to established guidelines; promotes to production on approval.
- Manages the code set process, including but not limited to review and update.
- Advises business areas on the development and/or update to operational procedures due to new configuration processes.
- Monitors, documents and reports on status, escalating as required.
- Develops and maintains required documents and reports, including but not limited to desk level procedures.
- Participates in QUsers subgroups by representing HPSJ’s business interests.
What You Bring:
Knowledge, Skills, Abilities and Competencies
Required
- In-depth subject matter knowledge in at least three health plan functional areas.
- In-depth knowledge of the features, functions and configuration of QNXT or similar system for at least three modules.
- Basic knowledge of database concepts and terminology, including interrelationships between data fields.
- Basic knowledge of procedure coding and medical terminology, and their application to provider setup.
- Basic knowledge of provider and/or facility contract and payment structures, and reimbursement practices, including capitation.
- Basic knowledge of and ability to plan, organize and execute basic configuration testing processes.
- Basic knowledge of the flow of data and information through a health plan.
- Basic knowledge of general medical benefits and exclusions.
- Produces work that is accurate and complete.
- Produces the appropriate amount of work.
- Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
- Rebounds from setbacks and adversity when facing difficult situations.
- Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
- Strong assessment and analytical skills, with ability to determine key issues, develop effective actions plans and implement to successful conclusion.
- Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
- Demonstrates a commitment to HPSJ’s strategy, vision, mission and values.
- Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
- Strong oral and written communication skills, with the ability to communicate professionally, effectively explain complex information, and document according to standards.
- Strong listening skills, with the ability to accurately receive and understand messages.
- Ability to work independently and as part of a team.
- Intermediate skills in Excel, Word, PowerPoint, Outlook, Visio and Windows.
- Intermediate SQL skills, with ability to do moderately complex queries.
- Ability to speak and be understood in English.
- Ability to treat confidential information with appropriate discretion.
Preferred
- Knowledge of Medi-Cal, Medicaid and/or Medicare program benefits and payment structures.
What You Have:
Education and Experience
Required
- Associate degree; and
- At least two years in configuration in a managed care health plan using QNXT or similar system; and
- Experience configuring at least three QNXT or similar system modules; or
- Equivalent combination of education and experience.
Preferred
- Experience in configuration in managed care, Medi-Cal, Medicaid and/or Medicare.
Licenses, Certifications
N/A
What You Will Get:
HPSJ Perks:
- Competitive salary
- Robust and affordable health/dental/vision with choices in providers
- Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
- CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
- Two flexible spending accounts (FSAs)
- Employer-Paid Term Life and AD&D Insurance
- Employer-Paid Disability Insurance
- Employer-Paid Life Assistance Program
- Health Advocacy
- Supplemental medical, legal, identity theft protection
- Access to exclusive discount mall
- Education and training reimbursement in addition to employer-paid elective learning courses.
- A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
- A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
- Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.
Our Vision:
Continuously improve the health of our community.
Our Mission:
We provide healthcare value and advance wellness through community partnerships.
We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.
HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics, or is associated with anyone who has or is perceived to have these characteristics.
Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.