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EZ-CAP Configuration Analyst
2 months ago
Job Title: EZ-CAP Configuration Analyst
Target Compensation Range: $80,000 - $95,000/year, depending on the relevant qualifications and experience.
About Us:
Astiva Health, Inc., based in Orange, CA, is a leading healthcare organization focused on Medicare and HMO services. We are dedicated to providing comprehensive care that meets the diverse needs of our community, emphasizing accessibility, affordability, and quality in all our offerings. Our mission is to enhance healthcare delivery and positively impact the lives of our members.
SUMMARY: Under the general oversight of the Manager of Information Systems, the Configuration Analyst is responsible for setting up and maintaining provider agreements, fee schedules, and code sets within the EZ-CAP claims processing system. This role also involves offering technical and administrative assistance to operational departments to ensure that system configurations and data are accurate and aligned with the operational and business requirements of Astiva Health and its partners.
KEY RESPONSIBILITIES:
- Conducts configuration tasks, including provider agreements, fee schedules, and DOFR.
- Establishes Benefits and ensures configurations comply with Astiva's Explanation of Coverage.
- Incorporates new or revised contract amendments, Medicare fee schedules, locality, ICD10, procedure codes, and revenue codes into EZ-CAP.
- Evaluates and audits claims payment accuracy against the contract data entered into EZ-CAP.
- Collaborates with the Manager of Information Systems to interpret and configure contract terms appropriately.
- Maintains comprehensive knowledge of EZ-CAP regulations regarding claims payments and authorizations.
- Designs, documents, and implements test plans for configuration testing to verify the accuracy of data entries.
- Adds value by addressing system configuration errors and proposing effective solutions.
- Handles claims adjudication and troubleshooting tasks.
- Ensures regular and consistent attendance.
- Performs other related duties as assigned.
EDUCATION and EXPERIENCE:
- Bachelor's degree in Healthcare Administration, Information Technology, or a related discipline.
- Minimum of 2 years of experience with EZ-CAP is essential.
- At least 2 years of experience in the Health Plan Medicare Line of Business.
- Experience with Medicare Reimbursement and Denial processes.
- Strong organizational skills with the ability to manage multiple tasks effectively.
- Familiarity with healthcare standard code sets, benefits, DOFR, RBRVS, and fee schedules.
- Understanding of CMS-1500 and UB-04 Medical Claim Forms.
BENEFITS:
- 401(k)
- Dental Insurance
- Health Insurance
- Life Insurance
- Vision Insurance
- Paid Time Off
