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Claims Configuration Specialist

1 month ago

Reston, Virginia, United States Bernard Nickels & Associates Full time
Job Summary

We are seeking a highly skilled Claims Configuration Analyst to join our team at Bernard Nickels & Associates. As a key member of our Business Configuration team, you will be responsible for ensuring the accuracy and integrity of provider agreements, fee schedules, and network data.

Key Responsibilities
  • Provide subject matter expertise for agreement, fee schedule, and network setup
  • Partner with cross-functional teams to ensure efficiency and accuracy of configuration requests
  • Write SQL queries to extract data from the database and analyze configuration data to identify clean-up activities
  • Ensure agreement configuration accuracy that may impact provider payment and member responsibility
  • Set up new Network and Agreement configurations into the Facets system
  • Validate agreement and network configuration utilizing claims testing, SQL queries, and Excel to ensure proper adjudication during claims processing
Requirements
  • Bachelor's degree preferred or equivalent work experience
  • SQL and Database experience
  • Possess understanding of the healthcare claims process
  • Claims system experience
  • Excellent analytical and problem-solving skills, quick learner
  • Strong communication and interpersonal skills
Desirable Qualifications
  • 5+ years of experience with the Facets platform
  • Medical Plan Benefit Configuration experience
  • Provider Network & Agreement Configuration experience