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HealthEdge Configuration Sr. Specialist (H&PS)

Job Location: AZ - Phoenix, CO - Denver, CT - Hartford, GA - Atlanta, IL - Chicago, MA - Boston, NJ - Florham Park, NY - New York, TX - Dallas, TX - Houston

Regional Description: Southwest

Job Number: 00513119


- Job description

Join Accenture and help transform leading organizations and communities around the world.  The sheer scale of our capabilities and client engagements and the way we collaborate, operate and deliver value provides an unparalleled opportunity to grow and advance.  Choose Accenture, and make delivering innovative work part of your extraordinary career.

People in our Client Delivery & Operations career track drive delivery and capability excellence through the design, development and/or delivery of a solution, service, capability or offering. They grow into delivery-focused roles, and can progress within their current role, laterally or upward.

Business & Technology Integration professionals advise upon, design, develop and/or deliver technology solutions that support best practice business changes

The Bus&Industry Integration Arch Specialist aligning technology with business strategy and goals they working directly with the client gathering requirements to analyze, design and/or implement technology best practice business changes. They are sought out as experts internally and externally for their deep functional or industry expertise, domain knowledge, or offering expertise. They enhance Accenture's marketplace reputation.

Role Summary

Support client implementations of HealthEdge’s HealthRules system by performing business rules configuration of provider contracts and benefits for health plans and collaborating with clients to design and build configuration


Primary Role Responsibilities

  • Translate provider contract and benefit summary provisions into HealthRules configuration parameters (e.g., fee schedules, benefit components) and HealthRules Language
  • Operate the HealthRules system to pay claims, run billing cycles, enroll members, setup providers
  • Develop configuration test plans, test configuration, troubleshoot defects and document testing results
  • Facilitate clients to gather configuration requirements and validate prototypes and testing
  • Design and advise new and enhancements to Accenture’s assets

Basic Qualifications

  • 3+ years of functional experience in the health payer industry, specifically in provider contract and pricing rule configuration, benefits configuration or claims adjustments or appeals
  • Experience interpreting professional, facility and ancillary provider contracts or benefit summaries and grids into systematic business rules
  • 6 months of experience implementing or supporting HealthEdge’s HealthRules software and with HealthRules Language (HRL) preferred
  • 3+ years configuration experience on similar payer systems (e.g. Facets)
  • Experience working on a full life cycle project adhering to Software Development Life Cycle (SDLC)
  • Strong communication, analytical and problem solving skills

Professional Skill Requirements

  • Proven success in contributing to a team-oriented environment 
  • Proven ability to work creatively and analytically in a problem-solving environment 
  • Desire to work in an information systems environment 
  • Excellent leadership, communication (written and oral) and interpersonal skills

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States and with Accenture (i.e., H1-B visa, F-1 visa (OPT), TN visa or any other non-immigrant status).

Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration. 

Accenture is a Federal Contractor and an EEO and Affirmative Action Employer of Females/Minorities/Veterans/Individuals with Disabilities.

Equal Employment Opportunity 
All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.

Accenture is committed to providing veteran employment opportunities to our service men and women.

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