Configuration Specialist, Associate

1 week ago


Rancho Cordova, California, United States Blue Shield of California Full time

Your Role

The Contract Compliance and Pricing Analytics Team is responsible for performing an in-line audit for all negotiated provider contracts.

The Contract Configuration Analyst, Associate will report to the Contract Compliance Manager.

Your Responsibilities

Conduct audits and run test claims to ensure future claims will be paid correctly based on the contractual terms.

Validate that the negotiated provider contracts were built correctly and according to the contract's specification.

Support process improvements by identifying possible gaps and addressing remediation.

Your Key Responsibilities

Analyze contract language to translate into specific pricing configuration with guidance.

Develop simple configuration approaches to support solution selection and develop documentation outlining the approach using appropriate documentation protocols.

Be accountable for the at least one contract type of configuration and testing of the assigned contracts.

Develop and execute claims tests to support the testing terms and services for in the negotiated contracts.

Your Deliverables

Provide configuration feedback through the audit process.

Analyze the provider contracts to ensure accuracy in the way it was built.

Identify and document audit observations and findings.

Service (internal customers) with an oriented/philosophy and work in a diverse, demanding and evolving environment where strong analytical, problem-solving skills, time management and organizational skills are required.

Requirements

Requires a bachelor's degree or equivalent experience.

0-2 years of prior relevant experience.

Requires strong medical claims knowledge and experience.

Knowledge of FACETS, CLMS, MS Office Suite.

Previous auditing experience and claims processing experience in a health plan.

Strong analytical and problem-solving skills, time management, and organizational skills.

Excellent interpersonal skills and ability to act as a team player.

Pay Range:

The pay range for this role is: $26.20 to $36.68 for California.



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