Job Description

SUMMARY :

As an integral member of the Medicare Advantage Operations team, the Tapestry Application Analyst plays a critical role in supporting the implementation and execution of organizational strategies related to Tapestry functionality-- including, but not limited to, AP claim life cycle, provider contracts, Optum PPS Pricing, fee schedules, responsibility mapping, authorization requirements, and overall configuration. The Tapestry Application Analyst will coordinate with the Configuration Manger to manage the day-to-day operations of the Configuration department. The Tapestry Application Analyst is responsible for ensuring accurate, compliant, and efficient configuration of the Tapestry claims processing system, regulatory and business rules, and provider contracts. The Tapestry Application Analyst will partner with the internal IS team, other operational department teams, and external vendors, as appropriate, to ensure the operational areas are configured in adherence with UCLA Health's contract provisions as well as all CMS and California regulatory requirements. The Tapestry Application Analyst will dedicate most of their work time (50% or more) to critical tasks related to current system configuration to ensure they are correct and in accordance with business and CMS requirements.

POSITION QUALIFICATIONS :

• Bachelor's degree in business administration, health care or equivalent work experience (3-5 years) preferred.
• Minimum of 3 years of Health Plan/IPA claims adjudication configuration, benefits, and/or provider contract configuration/analysis required.
• Epic Certifications in at least 2 of the following: Benefits Engine for Tapestry, Tapestry Accounts Payable Administration, Tapestry Claims and Contracts Administration, Tapestry Eligibility and Enrollment Administration, Tapestry Essential
• Experience in leading, facilitating, and implementing configuration to support new programs and/or projects required.
• Demonstrated skills in data analysis and presentation.
• Well versed in medical claims adjudication procedures, including the application of medical policy (authorizations) guidelines, contract pricing and member benefits. Required
• Experience with Microsoft Office Suite (Excel, Word, and PowerPoint) and data visualization tools.
• Comprehensive understanding of adjudication processes and associated applications.
• Extended experience of adjudication processes, analyzing benefit plan design and system application.
• Ability to understand the system's functionality and business policies.
• Ability to work within a team and as an individual contributor in a fast-paced, changing environment.
• Ability to prioritize all work deliverables effectively and independently.
• Excellent time management, organizational and written/verbal communication skills.
• Experience working on highly cross-functional project teams to produce meaningful results. Must be able to work effectively with both business and technical stakeholders at all levels including Management.
• Experience with coding and billing is optional, but a plus

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