Configuration - Manager Configuration 200-5002

JOB SUMMARY:

Coordinate the analysis of the production systems to increase the level of auto-adjudication. Enhance EDI capabilities and serve as a liaison between configuration and other departments. Responsible for designing, loading, testing and implementing all benefit and pricing tables into the company's database. Responsible for coordinating the design, load, test and implementing billing and capitation into the database system. Responsible for the claim payable process and claim refund process, collaborating with both claims and finance departments as required. Responsible for the Configuration and Operations Support auditing area, reviewing auditing methods to ensure quality minimums for staff are met or exceeded.

KEY RESPONSIBILITIES:

• Manage benefits, pricing, capitation and billing.
• Manage the auditing team of Configuration and Operations Support.
• Manage the claim payable process
• Manage the claim refund check process
• Liaison with other departments for system configuration issues on the company's database, including new product configuration, conversions, and maintenance.
• Determine system limitations and coordinate system configuration changes, or system enhancements, to obtain improved system performance and capitation processing.
• Evaluate the company's database for issues relating to adjudication of claims. Provide recommendations and test plans to improve adjudication rates.
• Performs other duties as assigned.

QUALIFICATIONS:

• Proficiency in the design and function of claims processing software
• Skilled in the development and implementation of claim processing procedures.
• Strong problem solving and organizational skills.
• Knowledge of medical terminology and CPT-4, HCPCS, ICD-10, revenue and DRG codes.
• Ability to manage multiple tasks simultaneously.
• Successful completion of Health Care Sanctions background check.
• Possess strong oral and written communication skills.
• Proficient in Microsoft applications.

EDUCATION/EXPERIENCE:

• Bachelor's degree in Business Administration or equivalent work-related experience.
• Minimum 5 years of healthcare claims processing system experience.
• Minimum 5 years previous management experience.
• Prior experience in a managed care environment preferred.
• Minimum 4 years of experience in Benefits, Pricing and Capitation Configuration.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Other details

• Job Family Commercial
• Pay Type Salary

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