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