Arizona Priority Care Plus is looking for only the best CLAIMS CONFIGURATION ANALYST to join our team!
Join a new and upcoming medical group that will provide:
- Clearly defined work, responsibilities, and reporting relationships
- Appreciation of your competence, conscientiousness, and loyalty
- Security in a stable work environment
- Competitive Compensation & Benefits Package
Arizona Priority Care Plus is a physician owned accountable care medical group that contracts with physicians, hospitals and other health care providers in the community to deliver affordable, quality health care on behalf of various health insurance companies. We are NOT a staffing company.
The CLAIMS CONFIGURATION ANALYST will understand and interpret provider contracts, benefits, authorizations and general configuration requirements to translate into EZ Cap configuration components that support the claim adjudication process. The analyst will be responsible for analysis, system design and input of authorization, claims general and/plan benefit data elements in EZ Cap the host processing system, and other platform applications to support accurate and timely payment of claims. This individual will evaluate, configure, and test new or modified managed care configuration within current Healthcare claims payer systems to function according to user requirements. The CCA will also analyze user requirements to automate processing or to improve existing systems, identify problems and learn specific input and output requirements. Act as lead for issues or complicated matters.
The essential talent require
- Bachelor's degree in business, health care or other applicable field; or, 4 additional years of equivalent experience
- 3 years experience in health insurance or managed care environment
- 3 years experience in claims processing/resolution
- 2 years of the any of following: membership, benefits, provider contracts & pricing, medical reviews, referral authorizations and code review and fee schedules
- Demonstrated ability to research, analyze, design, plan, organize, coordinate, implement, and perform necessary follow-up and closure procedures for system related deliverables
- Solid understanding of relational databases, systems testing and/or user acceptance testing
- Strong experience in documentation, research and reporting
- Proficiency in medical terminology, medical coding (CPT4, ICD9, and HCPCS), provider contract concepts and common claims processing/resolution practices
- Knowledgeable in state and federal regulations
- Proficiency in Microsoft Office including MS Access & query-based tools
To learn more about AzPCP, please visit us at www.az-pcp.com
Indeed - 19 months ago