QNXT Configuration Analyst at Educology Solutions – Washington, District of Columbia

ESI is seeking a QNXT Configuration Analyst that will be responsible for the configuration, maintenance, and optimization of the QNXT core claims processing system to support health plan operations. This role ensures accurate benefit setup, provider configuration, claims pricing, and system functionality in alignment with regulatory requirements, business rules, and contractual agreements.

The analyst partners with IT, Claims, Provider Relations, Compliance, and Business Operations to implement system changes, troubleshoot issues, and support ongoing system enhancements.

Key Responsibilities
System Configuration & Maintenance

Configure and maintain benefits, fee schedules, provider contracts, pricing rules, and claims editing logic within QNXT.

Implement and test system updates, enhancements, and regulatory changes.

Support new product implementations and benefit plan setups.

Configure accumulators, authorization rules, COB, and member eligibility parameters.

Claims & Provider Setup

Configure provider contracts, reimbursement methodologies, and payment rules.

Analyze and resolve configuration-related claims issues.

Support pricing validation and claims testing initiatives.

Ensure accuracy of benefit interpretation and adjudication logic.

Business & Regulatory Compliance

Ensure system configuration complies with CMS, state, and federal healthcare regulations.

Support audits and regulatory reporting initiatives.

Document configuration standards and change management processes.

Testing & Quality Assurance

Develop test cases and perform unit/system testing.

Validate configuration changes prior to production deployment.

Support UAT activities with business stakeholders.

Cross-Functional Collaboration

Work with Business Analysts and Developers on system upgrades and integrations.

Provide subject matter expertise for QNXT capabilities and limitations.

Participate in root cause analysis for production issues.

Required Qualifications

Bachelor’s degree in Information Systems, Healthcare Administration, Business, or related field (or equivalent experience).

3+ years of hands-on experience configuring QNXT.

Strong understanding of healthcare claims processing and managed care operations.

Knowledge of benefit configuration, provider contract setup, and fee schedule management.

Experience with SQL for data validation and analysis.

Understanding of HIPAA transactions (837, 835, 270/271).

Preferred Qualifications

Experience in Medicaid, Medicare, or Commercial health plans.

Familiarity with EDI processes and clearinghouse integrations.

Knowledge of CMS regulations and healthcare compliance standards.

Experience supporting QNXT upgrades or system migrations.

Technical Skills

QNXT Configuration Modules (Benefits, Pricing, Provider, Claims)

SQL querying and reporting tools

Microsoft Excel (advanced functions)

Incident management tools (ServiceNow or similar)

SDLC and change management practices