• Contract Config Anlyst-Provider

    Location US-CA-Monterey Park
    Job ID
    2018-6765
    Category
    Managed Care
  • Overview

    The Configuration Analyst is responsible for the activities related to system configuration and new health plan implementations, for accurately interpreting specific Health Plan Benefits, Contracts as well as additional business requirements and converting these terms to configuration parameters. This position is also responsible for coding, updating and maintaining provider contracts, fee schedules and various system tables through the user interface. This position will also serve as a peer auditor for provider data loads and updates.

    Responsibilities

    1. Initiate benefit configuration to include: load HP EOC benefit options i.e., co-pays, non-covered services and exceptions.
    2. Contract interpretation on Medicare and Medical fee schedules.
    3. Analyzes data by applying knowledge and experience to ensure appropriate information has been received.
    4. Loads and maintains provider contract reimbursement, financial responsibility tables and benefit options into computer system.
    5. Conducts Unit Testing when appropriate.
    6. Applies previous experience and knowledge to research and resolve claim/ issues, pended claims and update system as necessary.
    7. Reviews current benefit and DOFR configurations and suggests improvement processes to ensure systems are working more efficiently and improve quality.
    8. Supports Claims staff with complex claims issues.
    9. Performs other related duties as assigned.
    10. Performs peer auditing for provider demographic loads

     

    Qualifications

    1. High School Diploma or General Education Development (GED) required.
    2. 3 years of experience in Provider Information Management and/or processing medical claims experience.
    3. Bachelor's degree in business or health care administration, or other related field preferred.
    4. Knowledge in medical terminology, ICD-10, CPT and HCPCS.
    5. Strong critical thinking and analysis skills; verbal and written communications, and interpersonal interactions (e.g. partnering, conflict management, consulting, etc.).

     

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