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Posted: 10/21/2026Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare benefit configuration, including Prior Authorization and Pre-Determination processes, while leveraging strong analytical skills to enhance operational efficiency and compliance with CMS regulations. Proficient in data analysis and reporting, with a focus on continuous improvement and effective communication across multidisciplinary teams.
Highest-signal resume keywords
Healthcare Benefit ConfigurationData Analysis and ReportingPrior Authorization ManagementSQL ProficiencyHealthcare Coding Knowledge
Tech Stack
Tools & technologiesAbout the role
Key responsibilities & impact- Support implementation, maintenance, and governance of SCAN Health Plan’s Benefit Configuration, including Prior Authorization (PA) and Pre-Determination (PD) code sets
- Maintain PA and PD code sets across claims, utilization management, and related operational systems
- Support benefit configuration and prior authorization activities, including configuration, testing, validation, deployment, and post-implementation review
- Serve as a technical liaison for PA and PD configuration activities with internal teams, delegated entities, providers, and vendors
- Troubleshoot and resolve benefits- and authorization-related configuration issues, technical inquiries, and system problems impacting operational workflows
- Support Annual Enrollment Period readiness by completing assigned benefit configuration activities, validating configuration accuracy, and meeting implementation timelines
- Analyze data to identify trends, risks, process improvement opportunities, and operational or financial impacts
- Support continuous improvement initiatives by enhancing workflows, reporting capabilities, data quality, system functionality, and operational efficiency
- Create and maintain procedures, workflow documentation, training materials, and other resources supporting PA and PD list operations
- Maintain knowledge of healthcare coding standards, authorization processes, CMS regulations, healthcare technology, and related best practices
- Actively support the achievement of SCAN’s Vision and Goals
- Perform other duties as assigned
Requirements
What you’ll need- Bachelor's Degree or equivalent experience in Healthcare Administration, Health Information Management, Information Systems, Data Analytics, Business, Computer Science, or related field
- 2 or more years of experience in healthcare systems, operations, analytics, medical coding, utilization management, or related technical functions
- 2 or more years of experience with reporting, data analysis, SQL, or healthcare-related data
- Experience working with healthcare coding systems, code set maintenance, or authorization-related processes
- Knowledge of healthcare coding systems, including CPT®, HCPCS, and related code sets
- Understanding of healthcare claims processing, utilization management, authorization workflows, and healthcare operations
- Knowledge of CMS regulations and Medicare Advantage and Medicaid program requirements preferred
- Strong analytical and problem-solving skills, including data interpretation, issue identification, root cause analysis, and solution development
- Proficiency in data analysis, reporting, performance measurement methodologies, SQL, reporting tools, and business intelligence platforms preferred
- QNXT experience is required
- Proficiency with Microsoft Office Suite and related business productivity applications
- Excellent written and verbal communication skills with the ability to explain technical concepts to technical and non-technical audiences
- Strong organizational skills, attention to detail, and ability to manage multiple priorities and deadlines
- Demonstrated ability to work independently while collaborating across multidisciplinary teams
- Commitment to accuracy, quality, compliance, continuous improvement, and standard office-based work activities, including computer and office equipment use for extended periods
- Experience managing Prior Authorization or Pre-Determination Lists preferred
- Experience working with Medicare Advantage and/or Medicaid managed care programs preferred
- Experience supporting healthcare claims, utilization management, or medical policy operations preferred
- Experience with business intelligence tools such as Power BI preferred
- Familiarity with healthcare vendor platforms such as MHK, ikaSystems, CareAxis, or similar applications preferred
- Experience utilizing AI-enabled analytical tools and automation technologies preferred
- Coursework or training in healthcare analytics, healthcare informatics, business intelligence, or database management preferred
- Certification or coursework in SQL and Power BI preferred
- Certification in healthcare analytics, data visualization, business intelligence, or related technical discipline preferred
- A background check is required
Benefits
Comp & perks- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- Eleven paid holidays per year
- 1 floating holiday
- 1 birthday holiday
- Excellent 401(k) Retirement Saving Plan with employer match and contribution
- Robust employee recognition program
- Tuition reimbursement
- Equal pay
- Inclusive benefits
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data AnalysisHealthcare Coding SystemsSQLReporting ToolsPerformance MeasurementUtilization ManagementMedical CodingRoot Cause AnalysisWorkflow DocumentationProcess Improvement
Soft Skills
Analytical SkillsProblem-Solving SkillsOrganizational SkillsAttention to DetailCommunication Skills
Tools & Technologies
QNXTMicrosoft Office SuitePower BIBusiness Intelligence PlatformsHealthcare Vendor Platforms
Certifications & Qualifications
Certification in Healthcare AnalyticsCertification in SQLCertification in Power BICertification in Data Visualization
Industry Keywords
CMS RegulationsMedicare AdvantageMedicaidHealthcare OperationsAuthorization Workflows