Senior QNXT Configuration Subject Matter Expert (SME) – Healthcare

Location: Remote

Job Type: [Full-time/Contract]

Duration: 6-9 months

Rate:  Based on Experience

W2 hourly ONLY [No - H1B or 3rd Party Vendors]

Overview:

We are seeking a highly skilled Senior QNXT Configuration Subject Matter Expert (SME) with extensive experience in health plan operations and implementing claims systems. The ideal candidate will possess deep knowledge of QNXT configuration, ensuring optimal system performance, accuracy, and compliance. This role requires strong analytical skills, problem-solving abilities, and expertise in health plan claims processing, provider network management, system configuration and testing skills.

Key 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.

Qualifications:

• 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.
• Knowledge of health plan operations for Medicare, Medi-Cal, DSNP (duals) is highly preferred.
• Proficiency in troubleshooting system and configuration issues, with a focus on root cause analysis.
• Experience working with SQL and data analysis tools is a plus.
• 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).