Configuration Specialist

Job Description

Job Description

The Center of Excellence Specialist is responsible for completing daily tasks within the center of excellence related to configuration of The Health Plan's claims adjudication system. This position is highly focused on a team environment and will require collaboration between all areas of the business.

Required:

1. High school diploma/equivalent and/or two years experience working in health care operations, or equivalent experience.
2. Strong organizational skills.
3. Highly motivated individual with the ability to work independently.
4. Excellent written and verbal communication skill.
5. Ability to prioritize work while following guidelines to achieve departmental goals.
6. Team oriented.
7. Critical thinking abilities with strong problem solving skills.
8. Strong attention to detail.

Desired:

1. College degree preferred.
2. Ability to make effective decisions without oversight.
3. Prior experience with claims processing systems.
4. Prior experience with benefit plans and/or provider pricing

Requirements:

1. Create and attach benefit plan templates for all lines of business.
2. Assist with attaching all other components, such as, COB, referral, and capitation to Accounts.
3. Configure new provider contracts by writing Health Rules Language (HRL) based on contract terms.
4. Manage updates and/or annual configuration changes to provider contracts and benefit plans.
5. Collaborate with business leads when claims or provider issues fall to workbaskets.
6. Knowledge of claims processing edits and provider pricing in Source.
7. Provide assistance with message codes, code sets, and fee schedule updates.
8. Support and maintain pricing and benefit configuration in current claims processing system as well as HRP/Health Rules Payer.
9. Responsible for tracking and maintaining all configuration changes for audit purposes.

Equal Opportunity Employer

The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

8:00am -5:00pm
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