Job Description
CONTRACT CONFIGURATION SPECIALIST - HEALTHCARE
WORK FROM HOME
HOURS: 7AM-3:30PM, MON-FRI (FLEXIBLE HOURS)
PAY $23.00-$26.00/HOUR (BOE)
REQUIRED SKILLS:
- STRONG EXCEL SKILLS
- Ideal to have Contract configuration experience
- Medical billing claims processing and coding
- Familiarity with medical terminology
- Claims experience 2 years +
DAY TO DAY RESPONSIBILITIES:
WILL BE READING CONTRACTS, INTERPRETING CONTRACTS, CONFIGURING CONTRACTS INTO CLAIMS ADJUDICATION PROGRAM
JOB PROFILE SUMMARY
Position Purpose: The OPS Configuration and Integration Analyst creates, updates, tests and maintains system configuration tables and files to support accurate claims adjudication in a multiple product, multiple state, managed care environment.
EDUCATION/EXPERIENCE:
Bachelor’s Degree or an equivalent combination of education and experience in a managed care environment. Minimum two to three years’ experience in an automated medical claims environment and managed care/multiple product environment desired. Minimum one to two years’ experience in systems logic and testing desired.
JOB DESCRIPTION
- Analyzes, interprets, loads, tests and maintains configurable tables, files and software that are utilized to support claim adjudication which include but are not limited to; claim adjudication rules edits, pricing plan support, and provider reimbursement rules.
- Assists in development and execution of testing scenarios, test conditions. Performs unit and/or end user testing for new configuration, programming enhancements, new pricing 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 Health Net business strategies and marketplace trends to ensure business decisions meet future needs.
- Researches and resolves claim problems or issues that are pricing 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, editing and claim processing programs, Macess imaging system and claim related software packages that are utilized in claims adjudication.