Benefit Configuration Analyst - Hybrid

Company: Parkland Health and Hospital System (PHHS)
Location: Dallas
Posted on: May 3, 2025

Job Description:

Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family. PCHP is a Medicaid Managed Care Organization servicing Texas Medicaid and CHIP in the Dallas Service Area. PCHP works to fulfill of our mission by empowering members to live healthier lives. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day.Primary PurposeThe Analyst - Benefit Configuration (QNXT) ensures the accurate and timely setup and maintenance of benefits, contracts, and other critical configurations in the QNXT system. This role supports the health plan's operational and regulatory requirements by aligning system configurations with business rules and compliance standards.Minimum SpecificationsEducation

• Associate degree in business administration or related discipline required.
• Bachelor's degree preferred.Experience
• Three years of QNXT or other claims system configuration experience required.
• Experience with QNXT preferred.Equivalent Educaton and/or Experience:

• May have an equivalent combination of education and/or experience in lieu of specific education and/or experience. Skills or Special Abilities
• Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines. Ability to communicate complex information in understandable terms.
• Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization.
• Excellent analytical and problem-solving skills.
• In-depth knowledge of QNXT system configuration modules, including benefits, contracting, and fee schedule setup.
• Ability to interpret and implement business rules within claims system configurations.
• Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities.
• Ability to write clearly and succinctly with a high level of attention to detail.
• Proficient computer and Microsoft Office skills. Ability to learn new software programs.
• Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.ResponsibilitiesOperations
• Accurately configure and maintain benefits, contracts, prior authorizations, and fee schedules in QNXT to meet business and compliance needs.
• Accurately interprets specific state and/or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters.
• Work closely with the Configuration Manager to implement system updates, resolve challenges, and ensure smooth operational processes.
• Partner with teams such as Claims, IT, Provider Data Management, and Operations to gather requirements, troubleshoot issues, optimize workflows, maintain system integrity, validate configurations, and implement process improvements.
• Document configuration changes and create user-friendly documentation for future reference.Quality
• Integrate health literacy principles into all communication including Members and Providers.
• Support strategies that meet clinical, quality and network improvement goals.
• Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed.
• For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination.
• Troubleshoot and resolve configuration-related issues in collaboration with internal teams.
• Perform thorough testing and validation of configurations to support UAT and ensure accurate claims adjudication.
• Identify risks related to configuration and propose solutions to mitigate errors.
• Monitor system performance and recommend enhancements to improve efficiency and accuracy in claims processing.
• Stay current on industry trends, Medicaid/CHIP policy updates, and QNXT system enhancements to implement best practices.Regulatory
• Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements.
• Conduct regular audits to ensure system configurations align with operational requirements and regulatory standards.
• Ensure compliance with Texas Medicaid/CHIP regulations, NCQA standards, and organizational policies.Professional Accountability
• Promotes and supports a culturally welcoming and inclusive work environment.
• Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
• Adheres to organizational policies, procedures, and guidelines.
• Completes assigned training, self-appraisal, and annual health requirements timely.
• Adheres to hybrid work schedule requirements.
• Attends required meetings and town halls.
• Recognizes and communicates ethical and legal concerns through the established channels of communication.
• Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
• Maintains confidentiality at all times.
• Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies.Job Accountabilities
• Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
• Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
• Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.Parkland Community Health Plan (PCHP) prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.

Keywords: Parkland Health and Hospital System (PHHS), Wylie , Benefit Configuration Analyst - Hybrid, Professions , Dallas, Texas