Healthcare IS ยท 19 hours ago
QNXT Configuration SME
United States
Contract
Remote
Senior Level, Lead/Staff
10+ years expHealthcare IS is seeking a highly skilled Senior QNXT Configuration Subject Matter Expert with extensive experience in health plan operations and implementing claims systems. The ideal candidate will ensure optimal system performance, accuracy, and compliance while leading the implementation and configuration of QNXT.
ConsultingData IntegrationElectronic Health Record (EHR)Health CarePharmaceutical
Responsibilities
Lead and manage the implementation and configuration of QNXT to support health plan operations
Serve as a subject matter expert, providing guidance on best practices, troubleshooting, and issue resolution
Collaborate with cross-functional teams, including IT, claims, provider services, and business operations, to implement and enhance system configurations
Develop, document, and maintain configuration standards, policies, and procedures
Analyze and validate system configurations to ensure accurate claim adjudication and provider reimbursement
Identify opportunities for system enhancements and automation to improve efficiency and reduce errors
Support system testing, upgrades, and implementations to ensure seamless transitions and minimal disruption
Provide training and knowledge transfer to internal teams and stakeholders
Qualification
Required
10+ years of experience with QNXT configuration in a healthcare or health plan environment
Strong understanding of health plan claims processing, provider contracts, fee schedules, utilization management and benefits configuration
Proficiency in troubleshooting system and configuration issues, with a focus on root cause analysis
Ability to manage multiple tasks, meet deadlines, and work collaboratively in a fast-paced environment
Excellent communication and stakeholder management skills
Bachelor's degree in Healthcare Administration, Information Systems, Business, or related field (or equivalent experience)
Preferred
Knowledge of health plan operations for Medicare, Medi-Cal, DSNP (duals) is highly preferred
Experience working with SQL and data analysis tools is a plus
Company
Healthcare IS
Healthcare IS is a consulting firm that extends its services in the areas of pharmacy, revenue cycle management and data warehousing.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Catherine Dargin
CPOE Pharmacist Analyst
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