• Contract Configuration Analyst – Provider Contracting

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

    Contract Configuration Analyst is responsible for the activities related to system configuration and new health plan implementations. Interpret specific health plan benefits, contracts, as well as additional business requirements and converting these terms to configuration parameters. 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. Receives data from Sr. Management or designee for update of data in computer system.
    2. Analyzes data by applying knowledge and experience to ensure appropriate information has been received.
    3. Loads and maintains provider contract reimbursement and benefit into computer system.
    4. Conducts Unit Testing when appropriate.
    5. Applies previous experience and knowledge to research and resolve claim/encounter issues, pending claims and update system as necessary.
    6. Suggests improvement processes to ensure systems are working more efficiently and improve quality.
    7. Supports claims staff with complex claims issues.
    8. Performs other related duties as assigned.

    Qualifications

    1. Bachelor’s degree in Business Administration, healthcare, or related field or equivalent work experience required.
    2. Minimum of 3 years’ experience interpreting provider and health plan contracts
    3. Minimum of 3 years working experience in EZ Cap systems and configuring contracts.
    4. Knowledge in medical terminology, ICD-9/10, CPT and HCPCS.

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