Configuration Specialist
Apex Systems Inc - Madison, WI

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Our client in Madison, WI has a need for a configuration specialist-direct hire:

ESSENTIAL JOB DUTIES

- Evaluating production and process impact of system changes

- Assisting with system maintenance and ongoing support

- Performing training as needed on processes and configuration related to functional areas assigned

- Assisting with installing, integrating and testing system upgrades including work with pertinent vendors and tools

- Serving as a team resource for questions, concerns, and remediation that require technical research and/or changes to configuration generally discovered through testing or claims processing

- Identifying and detailing function-specific configuration needs

- Communicating functional configuration designs to leader; assisting in prioritization

- Performing manual data loads and assisting with automated files and interfaces

- Maintaining and updating technical workbooks and process documentation

- Assisting with developing and completing interfaces, required reports and related analysis as needed

- Understanding coding and modifiers in order to ensure configuration supports the most current version of ICD-9/10, CPT, and HCPCS codes in agreement with government payors and commercial insurance standards to guarantee HIPAA compliance. Working cross-functionally with Benefit Team to analyze these code sets and meet requirements of pricing contracts and product configuration.

- Ensuring all reimbursement is based on the providers contract and status. Creating networks, contracts, payclasses, keywords, and service qualifiers to support contract provisions.

ADDITIONAL JOB DUTIES

- Coordinating, tracking and implementing annual fee schedule updates with close interaction and support from Provider Pricing Support Analyst, Contracting, Provider Relations, and IT.

- Providing quarterly provider count to internal company departments for use on RFPs and other needs.

- Providing production assistance with EX code processing as needed

- Participating in special projects and committees as assigned

REQUIRED SKILLS

The requirements for this position include:

- Strong organization and communication skills

- Experience training employees on processes and procedures

- Ability to write and implement test plans

- Ability to maintain semi-technical documentation

- Ability to work in fast paced, team environment with frequent changes in priorities and operation processes

- 3 or more years experience at the health insurance company and a combination of pricing, provider support, benefit plan building or system configuration. Claims experience may account for some but not all of the required experience.

- Experience with contracts and reimbursement methodologies

- Experience in healthcare provider network management, provider demographics

- Experience in technical, system integration implementations

- Experience with listing and requirements gathering

- Experience working in large claims processing systems such as MetaVance, Trizetto, Facets, QNXT, Amysis or MHS

- Demonstrated analytical skills; ability to define and interpret requirements

- Proficient in Microsoft Excel ability to compare data, pivot tables, forms and functions

- Proficient in Microsoft Word and Visio

PREFERRED SKILLS

- BA/BS degree in related field.

- 3 or more years experience at a health insurance company a combination of pricing, provider support, benefit plan building or system configuration.

- Project Management experience and training

- Ability to understand technical documentation

About this company
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Apex Systems is an IT staffing and services firm. We specialize in providing IT professionals for contract, contract-to-hire, and direct...