EZ-CAP Configuration Analyst

2 months ago


Orange, California, United States Astiva Health, Inc Full time

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. is a leading healthcare organization dedicated to providing Medicare and HMO services. Our commitment is to deliver comprehensive care that meets the diverse needs of our community, emphasizing accessibility, affordability, and quality in every aspect of our operations. We strive to enhance healthcare delivery and positively impact the lives of our members.

SUMMARY: Under the general supervision of the Manager of Information Systems, the Configuration Analyst is responsible for setting up and maintaining provider agreements, fee schedules, and coding systems within the EZ-CAP claims processing platform. This role also offers 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.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

  • Conducts configuration tasks which may involve provider agreements, fee schedules, and DOFR.
  • Establishes Benefits and ensures configurations align with Astiva's Explanation of Coverage.
  • Integrates new or revised contract amendments, Medicare fee schedules, locality adjustments, ICD10, procedure codes, and revenue codes into EZ-CAP.
  • Tests and audits claims payment accuracy against the contract data integrated into EZ-CAP.
  • Collaborates with the Manager of Information Systems to interpret and configure contract terms appropriately.
  • Maintains a comprehensive understanding of EZ-CAP regulations related to claims payments and authorizations.
  • Develops, documents, and implements testing plans for configuration validation and data accuracy.
  • Adds solutions to system configuration errors and unresolved issues.
  • Handles claims adjudication and troubleshooting tasks.
  • Ensures regular and consistent attendance.
  • Performs other duties as assigned.

EDUCATION and/or EXPERIENCE:

  • Bachelor's degree in Healthcare Administration, Information Technology, or a related discipline.
  • Minimum of 2 years of experience with EZ-CAP is required.
  • At least 2 years of experience in the Health Plan Medicare Line of Business.
  • Experience with Medicare Reimbursement and Denial processes.
  • Strong organizational abilities with the capacity to multitask and manage time effectively.
  • Familiarity with healthcare standard code sets, benefits, DOFR, RBRVS, and fee schedules.
  • Knowledge of CMS-1500 and UB-04 Medical Claim Forms.

BENEFITS:

  • 401(k)
  • Dental Insurance
  • Health Insurance
  • Life Insurance
  • Vision Insurance
  • Paid Time Off


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