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Contract Configuration Specialist Partially Remote

Company: ApolloMed
Location: Arcadia
Posted on: November 19, 2022

Job Description:

SUMMARYThe Contract Configuration Specialist will understand the types of provider contracting arrangements and/or benefits administration data elements that need to be configured in the existing application and other platform applications to support the accurate & timely payment of claims for the Regions' Claims systems. Test new releases, make recommendations on system enhancements, and evaluates contracts for configuration which includes system capabilities. Consults with appropriate internal partners on issues and interpretations. Works with Manager & Supervisor to define, code, configure and maintain detailed provider services. The specialist should clearly understand the products and healthcare benefits services offered to our customers, including cost share, limits and regulatory rules and guidelines.ESSENTIAL DUTIES AND RESPONSIBILITIESPerforms configuration activities which may include provider contracts, fee schedule, and DOFREnsures the provider authorization & benefits configuration meets established business rules & proceduresLoads new/updated payor and payee contracts, amendments, fee schedule, locality, ICD-9 and ICD-10, procedure codes, and revenue codes into EZ-CAPMonitor contract updates & contract(s) matrixTest and audit claims payment accuracy against contract information loaded into EZ-CAPConsults with relevant Claims Manager, Contract Manager, and Business Analyst to determine appropriate interpretation & configuration of contract termsMaintains detailed knowledge & understanding of EZ-CAPrules relative to claims paymentDevelops, documents & executes test plans forconfiguration testing & validate accuracy of data loadedCoordinates research & resolution of debarred & sanctioned providers & ensures communication of required system updates to Provider Contracting & Claims operationsAdd PCF (Provider Can't Find) into EZ-CAP. Verify W-9, NPI, Taxonomy codes, class codes, & Specialty codesAssume other duties as directed#LPIND

Keywords: ApolloMed, Arcadia , Contract Configuration Specialist Partially Remote, Other , Arcadia, California

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