SUMMARY OF POSITION:
The Configuration Specialist is responsible for set-up in the claims processing database, of all provider data. The Configuration Specialist will work closely with the Claims department, Provider Relations, Contracting and Account Management to ensure all data is up to date and accurate in the system.
DUTIES AND RESPONSIBILITIES:
- Configure all provider records in Carisks’s Enterprise System
- Create vendors, practice locations, groups, and networks
- Configure all provider agreements as they pertain to contracting, network management and credentialing
- Create and maintain fee schedules linking the fees to the appropriate contracts.
- Ensure the provider reimbursement is configured, implemented with the application of business rules, and maintained in the claim system.
- Configure codes and benefits with a focus on achieving the highest possible auto-adjudication rate.
- Maintain inventory and productivity reporting, meeting established productivity standards
- Resolves system issues concerning claims, contract interpretation and general provider demographic operational issues.
- Update provider contract changes in the system
- Run, review, and distribute monthly client and management reports
POSITION REQUIREMENTS:
- Bachelor’s degree in Business or HealthCare Administration
- 2 years prior healthcare experience in provider configuration or benefit plan building
- Strong knowledge of claims processing and procedures
- Ability to communicate effectively, both orally and in writing
- Ability to plan, organize and prioritize task assignments
- Knowledge of government healthcare plans, Medicaid/Medicare
- Proficient in Microsoft Excel
- Knowledge of Plexis Claims Management is a plus.
- Bi-lingual is preferred
OTHER DUTIES:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.