Claims Configuration Analyst (HYBRID)

Type: W2 Contract (NOTE: Employer Sponsorship can NOT be offered for this position. No C2C/C2H.)

Start Date: ASAP

Duration: 6 Months

Location: Mason, OH (HYBRID; in-office 2 days per week)

Schedule: Monday-Friday, 8am to 5pm EST (8 work hours per day, 40 work hours per week).

Pay Range: $38 to $44 per hour

GENERAL FUNCTION:

The Claims Configuration Analyst will serve as an Analyst on the Business Configuration team, responsible for provider agreement, fee schedule and network data integrity initiatives. Provide subject matter expertise for agreement, fee schedule and network setup. Partner with cross functional teams to ensure efficiency and accuracy of configuration requests.

REQUIREMENTS:

Bachelor s degree preferred OR equivalent work experience

SQL and Database experience

Possess understanding of the healthcare claims process

Claims system experience

Excellent analytical and problem-solving skills, quick learner

Strong communication and interpersonal skills

Top 3 Desirable Qualifications:

5+ years of experience with the Facets platform

Medical Plan Benefit Configuration experience

Provider Network & Agreement Configuration experience

RESPONSIBILITIES:

Writing SQL queries to extract data from the database, analysis of configuration data to identify clean-up activities.

Ensure agreement configuration accuracy that may impact provider payment and member responsibility.

Set up new Network and Agreement configurations into the Facets system.

Validate agreement and network configuration utilizing claims testing, SQL queries and Excel to ensure the configuration properly adjudicates during claims processing, for member benefit, reimbursements and provider pay amounts.

Perform and resolve network and agreement configuration questions/issues sent to the Business Configuration team without guidance.

Maintain relationships with Account Managers, and Provider teams in order to develop a cohesive cross functional, results driven working environment.

Self-manage completion of work inventory within established quality and turnaround time guidelines.

Coordinate and participate in cross-functional team activities for issue resolution.

Recommend process and system enhancements to drive improvements.

Support the management team with on-going training activities, misc. projects, resolving issues, and serving as a subject matter expert for all Configuration requests.

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