Provider Contract Pricing Configuration Analyst - Hybrid

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 Purpose

The Provider Contract Pricing Configuration Analyst (QXNT) ensures the accurate and timely setup and maintenance of provider contract and pricing configurations within the QNXT system and NetworX Pricer. This role ensures alignment with business requirements, regulatory compliance, and operational needs to support claims adjudication and provider payment accuracy.

Minimum Specifications

Education

- Associate degree in business administration or related field required. Bachelor's degree preferred.

Experience

- Three years of QNXT or other claims system configuration experience required.

- Experience with NetworX Pricer or equivalent pricing tools preferred.

Equivalent Education 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.

- Strong Knowledge of QNXT configuration modules related to provider contracts and pricing.

- Understanding of reimbursement methodologies, including DRG, RCCs, DPPs, capitation, and custom fee schedules.

- Knowledge of NetworX Pricer configuration processes and claims pricing workflows.

- Proficient in interpreting and implementing complex contract terms within claims systems.

- 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, Microsoft Office skills, and other analytical tools. 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.

Responsibilities

• Operations Configure and maintain provider contracts, fee schedules, and pricing rules within QNXT and NetworX Pricer to support accurate claims adjudication. 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 Issue, maintain system integrity, validate configurations, and implement process improvements. Document configuration changes and create user-friendly documentation for future reference. Serve as a subject matter expert for provider contract and pricing configurations, providing guidance and training as needed. - 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. Regularly audit configurations to ensure consistency and accuracy in pricing and payments. Conduct thorough testing and validation of contract and pricing configurations to ensure accurate claims pricing and payment workflows. Support user acceptance testing (UAT) and resolve issues identified during testing. Document testing results and maintain comprehensive records of configuration changes. 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 - Ensure work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements. Ensure all configurations comply with regulatory requirements, operational standards, and business rules. 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 employees position, qualifications, and competencies.

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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.