Contract Configuration Analyst I

POSITION SUMMARY

The Configuration Analyst I will be responsible for supporting all aspects of system configuration ensuring that all system configurations are programmed accurately for Authorizations and Claims.

RESPONSIBILITIES-DUTIES

• Configure rates based on provider contracts to ensure accurate payments of claims and capitations to providers.
• Configure rates based on vendor contracts to ensure accurate payments.
• Maintain system configuration based on data received from contracting
• Audit accuracy of Fee schedules in test environment prior to in-loading in production
• Assign Fee Set Assignments by line of business or health plan code
• Program and audit Interest Payment
• Program and audit RBRVS Geographical Adjustment
• Apply previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system as necessary
• Coordinating with internal departments to resolve and assist with system related issues/builds
• Other duties may be assigned by the Supervisor of Contract Configuration or Manager of Contract Configuration.
• Ability to handle fluctuating volumes of work and be able to prioritize work to meet deadlines and needs of user community.

EDUCATION & EXPERIENCE REQUIREMENTS

• Minimum 5 years of administrative healthcare experience preferred
• High School Diploma or GED, some college preferred

• Experience with benefits and system configuration and interpretation
• Medical terminology, CPT, Revenue codes, ICD10, RBRVS, HCPCS, HIPPS code sets
• Must have experience with all lines of business, Medicare, Medi-Cal, and Commercial claims and know industry guidelines
• Knowledge of software applications such as EZCAP is a plus

• Must be familiar with Microsoft Office (Word, Excel, Outlook, Microsoft, Access, SQL)

• Follow up on assignments, show initiative, be self-motivated, and have a strong work ethic
• Possess strong time management skills, including the ability to prioritize deadlines on multiple projects.
• Produce accurate and high-quality work on time and consistently.
• Individual should also demonstrate the ability to work with all levels of staff within AMM
• Must be highly organized and able to perform multiple tasks efficiently, be computer literate
• Ability to work in a fast-paced environment

• Strong analytical skills and problem solving skills are necessary
• Must obtain a positive attitude and have excellent communication skills