**Please note: This position is with Nova, a division of Independent Health Corporation (a subsidiary of Independent Health).**
The Core System Implementation Specialist is responsible for all tasks related to ensuring that all plans, tables and configurations are built on Eldorado (ECI) according to the self-funded employer’s summary plan description (SPD), and the interpretation of each benefit, including, but not limited to, authorization requirements, copayments, usage limitations, coinsurance and deductibles. The Core System Implementation Specialist is expected to identify, research, and resolve inaccuracies and inconsistencies in the system as they impact claims payment and drive increased auto adjudication. The Core System Implementation Specialist will maintain the system via updates to benefit tables and system components as released by the vendor, including service and diagnosis codes. The Core System Implementation Specialist is expected to work closely with other departments ensuring the accuracy of the plan build, auto-adjudication improvements and creating and maintaining client approved benefit grids. Duties include, but are not limited to:
- ECI Plan build/table maintenance
- New group implementation
- Benefit grid maintenance
- Monitor and increase auto-adjudication results
- Investigate issues both global and limited plan level
- Manage the ECI workflow configuration and day to day issue resolution
- Benefit code maintenance
- System updates and user acceptance testing
- Accumulator adjustments
- Attend various training sessions and conferences as related to the position and industry; may include travel
- Subject matter expert on projects related to legislation compliance and data conversion efforts
Associates degree from an accredited institution or Bachelor’s degree preferred. Experience in a healthcare insurance or operational/transactional environment will be considered in lieu of a degree. Experience in self-funded insurance, or system configuration is required.
A minimum of three (3) years of healthcare related experience with a strong emphasis on customer service, claims payment and reimbursement methodology required. Expertise in CPT, ICD, and Revenue, HCPC coding and medical terminology required.
Demonstrated interpersonal and process management skills with the ability to recognize interdepartmental relationships and dependencies and implement departmental activity in support of cross-functional policy and procedure modification.
Excellent written and verbal communication skills with the ability to focus and clarify concepts; strong analytical skills; must be comfortable and confident with presenting solutions and recommendations to clients.
Demonstrated research and problem solving skills; decision making abilities with effective organizational and time management skills and the ability to handle multiple projects and prioritize effectively.
Strong computer skills. Proficiency in Word, Excel and Power Point required. A working knowledge of core business systems preferred.
Must exhibit initiative, decisiveness, and creativity, along with self-motivation with the ability to assume responsibility and maintain strict confidentiality.
Understands the importance of maintaining the physical and technical security and privacy of protected health information (PHI).
Independent Health is an equal opportunity employer.