Avera Health Plans

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Pay Range:

The pay range for this position is listed below. Actual pay rate dependent upon experience.

$53,040.00 - $79,560.00

Position Highlights

Looking for Candidate with Medical Coding background.

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

The Avera Health Plan Configuration Analyst is responsible for the design, implementation, and support of the Epic Tapestry module, which manages health plan administration, benefits, fee schedules, claims, enrollment, care coordination, clinical/authorizations and provider data. This role ensures that managed care workflows are optimized and aligned with organizational goals, regulatory requirements, and member-centered care initiatives. As a Configuration Analyst you will work closely with clinical, operational, and technical stakeholders to translate complex business needs into efficient system solutions, while maintaining the integrity and performance of Epic applications.

What you will do

• System Configuration & Optimization: Build, test, implement, and maintain Epic Tapestry components and functional workflows. Converting benefit plan requirements into system configurations, collaborating with other analysts and business leaders, ensuring data accuracy, customizing settings to support payer-provider relationships and supporting the system's ongoing performance. Develop and improve workflows and business processes to improve customer service, decrease operational administrative costs, and improve overall health plan outcomes and quality. Collaborate with Epic and internal teams to implement and test new features and enhancements on a quarterly basis.
• System Support & Troubleshooting: Provide support for Epic Tapestry-related issues, including performing root-cause analysis, resolution, documentation of results and present business impact analysis for proposed configuration changes. Monitor existing system performance and make configuration recommendations, where appropriate, to maintain acceptable levels of automation in claims adjudication and member enrollment, workflows and accurate claims payment.
• Stakeholder Collaboration: Partner with internal teams, including health plan business and functional operations teams, Avera system stakeholders for other Epic applications and IT staff, to ensure accurate and compliant system configurations. Work closely with operational teams to interpret functional operating procedures and align system capabilities with operational goals. Provide input on system design to improve efficiency and reduce administrative burden. Collaborate with data integration and reporting teams to ensure data consistency and performance.
• Requirement Analysis: Uses experience and judgement to plan and accomplish goals; performs a variety of complicated tasks to ensure that the core claims system is configured correctly by reviewing the system components and validating that the configuration aligns to legal plan documents and regulatory requirements. Interpret and analyze plan documents, such as Evidence of Coverage (EOCs), fee or rate schedules, policies, code set changes and translate into technical specifications for the system.
• Data management: Provides analysis and documentation that supports configuration management, design, requirements traceability, and audit controls needed to meet state and federal regulatory requirements. Work with Epic Chronicles and data models, and understand relevant EDI (Electronic Data Interchange) formats like 834, 837, and 835.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

• Bachelor's Bachelor's degree in Healthcare Administration, Information Systems, or related field or Epic Tapestry Certification with 3+ years of experience.
• Epic Certification - Epic Epic Tapestry certification or required to participate in Epic coursework and pass certification exams within 90 days of hire. within 90 Days
• Demonstrated critical thinking skills through evaluation, analysis, and creative solutions.
• Ability to think broadly, identifying and understanding implications to the entire organization including excellent communication, documentation and problem-solving skills.
• Ability to work independently and as part of a cross-functional team.

Preferred Education, License/Certification, or Work Experience:

• 4-6 years Experience with complex system design, preferred experience with claims adjudication platforms or ecosystems, specifically Epic Tapestry.
• Background and knowledge of Health Plan operations and understanding of health plan processes, systems and regulations including claims processing, benefit configuration, enrollment and provider networks. Including familiarity with CMS regulations, HIPAA and payer-provider contracting.
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
• Experience with Epic Chronicles and data models, Care Management or other related modules.
• Familiarity with EDI (Electronic Data Interchange) formats (e.g., 834, 837, 835) and integration best practices.
• Professional and/or facility coding familiarity.

Expectations and Standards

• Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera’s values of compassion, hospitality, and stewardship.
• Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.

• Up to 5% employer matching contribution for retirement

• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to [email protected].