Apex Systems has an opportunity for a Configuration Specialist in the Tampa area with a large healthcare company. Please review the details below to determine if this would be something that you are interested in and qualified for.
If you would like to learn more about this opportunity and be considered for the role please send an up to date resume to Aly Hardy, Technical Recruiter, at email@example.com
Job Title: Configurations Analyst
Duration: 6 month contract to hire
Overview: Oversees accurate and timely development of price rules and contract templates. Develops new business plans that will help
promote technology and automation.
Key Duties and Responsibilities:
- Prepare files for loading onto claims platform
- Track project plan and gather updates concerning provider data from team leads as needed
- Build pricing packages
- Load provider files and audit completion
- Build rules within the Peradigm System, in coordination within State and Federal guidelines.
- Monitor and test the accuracy of price rules.
- Research both State and Federal mandates and build interpretation grids.
- Build and test contracts and price templates for the non-par and new business teams.
- Work with all regions on non-par documentation.
- Train/monitor staff on contract pricing and contract templates.
- Resolve provider load issues within appropriate time.
- Ensure proper supporting documentation and maintain files for all price rules.
- Resolve critical errors forwarded from the claims department.
- Build and maintain positive business relationships with business partners.
- Load professional contracts into the Xcellis/Diamond System through appropriate research and provider data load activities.
Excel, spreadsheets, Xcelys (Paradigm) Experience
Ability to Read contracts
Building Pricing Logic Experience
Understanding of the rules and regulations of Medicare and Medicaid
1+ year of experience in Analytical Role
1+ year of experience in health insurance
Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
Understanding of contract terms and how they are loaded into the system
Understanding of provider maintenance and termination processes.
Knowledge of provider billing practices.
Knowledge of claims processing.
Apex is an Equal Employment Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at 844-463-6178