Job Description

Contract Configuration Specialist - Healthcare Insurance/Medical Claims

MS EXCEL EXPERIENCE NEEDED!!

JOB SUMMARY Creates, updates, tests and maintains system configuration tables and files to support accurate claims adjudication in a multiple products, multiple states, managed care environment.

DETAILS

• Pay: BASED ON EXPERIENCE - Roughly $25-28/Hour
• Location: Remote (anywhere in AZ or CA)
• Schedule: M-F (8-5)

RESPONSIBILITIES

• Analyzes, interprets, loads, tests and maintains configurable tables, files and software that are utilized to support claim adjudication which include and but are not limited to; claim adjudication rules edits, benefit plan support, and provider reimbursement rules.
• Assists in the development and execution of testing scenarios, test conditions. Performs unit and/or end-user testing for new configuration, programming enhancements, new benefit designs, new provider contracts, and software changes as necessary that effects claim adjudication rules.
• Proactively identifies opportunities and recommends system solutions that increase automation, resolves system deficiencies and enhance claims processing to meet and exceed business requirements. Stays abreast of company business strategies and marketplace trends to ensure business decisions meet future needs.
• Researches and resolves claim problems or issues that are configuration related in a timely and accurate manner. Develops system queries to determine the scope of the problem and recommends possible solutions to management. Technical reference for other areas in translating system specifications and operations.
• Interacts and coordinates system programming changes and schedules as necessary with the IS Business Analysts and Programmers.
• Develops and maintains a comprehensive knowledge of the claims adjudication rules, MC400 editing and claim processing programs, Macess imaging system and claim related software packages that are utilized in claims adjudication.

EDUCATION/EXPERIENCE

• Bachelor’s Degree OR an equivalent combination of education and experience in a managed care environment.
• Minimum two to three years of experience in an automated medical claims environment and managed care/multiple product environment Required.
• Minimum one to two years of experience in systems logic and testing.

Company Description

At Wollborg Michelson, we are committed, tenacious, and passionate about what we do. Whether you're a company trying to fill a position with a highly specific profile, or a candidate searching for the right opportunity to match your unique skillset, we know the challenges you face. More importantly, we have the expertise, experience, and drive to overcome them. We have been respected for decades, but earn our reputation every day.