Contract Configuration Analyst I

3 weeks ago


Long Beach, United States Advanced Medical Manage Full time $22 - $30
Job DescriptionJob Description


POSITION SUMMARY

The Configuration Analyst I will be responsible for supporting all aspects of system configuration ensuring that all system configurations are programmed accurately for Authorizations and Claims.

RESPONSIBILITIES-DUTIES

  • Configure rates based on provider contracts to ensure accurate payments of claims and capitations to providers.
  • Configure rates based on vendor contracts to ensure accurate payments.
  • Maintain system configuration based on data received from contracting
  • Audit accuracy of Fee schedules in test environment prior to in-loading in production
  • Assign Fee Set Assignments by line of business or health plan code
  • Program and audit Interest Payment
  • Program and audit RBRVS Geographical Adjustment
  • Apply previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system as necessary
  • Coordinating with internal departments to resolve and assist with system related issues/builds
  • Other duties may be assigned by the Supervisor of Contract Configuration or Manager of Contract Configuration.
  • Ability to handle fluctuating volumes of work and be able to prioritize work to meet deadlines and needs of user community.

EDUCATION & EXPERIENCE REQUIREMENTS

  • Minimum 5 years’ of administrative healthcare experience preferred
  • High School Diploma or GED, some college preferred
  • Experience with benefits and system configuration and interpretation
  • Medical terminology, CPT, Revenue codes, ICD10, RBRVS, HCPCS, HIPPS code sets
  • Must have experience with all lines of business, Medicare, Medi-Cal, and Commercial claims and know industry guidelines
  • Knowledge of software applications such as EZCAP is a plus
  • Must be familiar with Microsoft Office (Word, Excel, Outlook, Microsoft, Access, SQL)
  • Follow up on assignments, show initiative, be self-motivated, and have a strong work ethic
  • Possess strong time management skills, including the ability to prioritize deadlines on multiple projects.
  • Produce accurate and high-quality work on time and consistently.
  • Individual should also demonstrate the ability to work with all levels of staff within AMM
  • Must be highly organized and able to perform multiple tasks efficiently, be computer literate
  • Ability to work in a fast-paced environment
  • Strong analytical skills and problem solving skills are necessary
  • Must obtain a positive attitude and have excellent communication skills




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