Senior Configuration Specialist *Hybrid*

Description

Job Title: Senior Configuration Specialist

Department: Operations - Claims

About the Role:

We are currently seeking a highly motivated Configuration Specialist. This role will report to a Manager - Claims and enable us to continue to scale in the healthcare industry.

What You'll Do:

• Performs configuration activities which may include provider contracts, fee schedule, and DOFR
• Ensures the provider authorization & benefits configuration meets established business rules & procedures
• Loads new/updated payor and payee contracts, amendments, fee schedule, locality, ICD-9 and ICD-10, procedure codes, and revenue codes into EZ-CAP
• Monitor contract updates & contract(s) matrix
• Test and audit claims payment accuracy against contract information loaded into EZ-CAP
• Consults with relevant Claims Manager, Contract Manager, and Business Analyst to determine appropriate interpretation & configuration of contract terms
• Maintains detailed knowledge & understanding of EZ-CAP rules relative to claims payment
• Develops, documents & executes test plans for configuration testing & validate accuracy of data loaded
• Coordinates research & resolution of debarred & sanctioned providers & ensures communication of required system updates to Provider Contracting & Claims operations
• Responds to system configuration flaws/errors and unresolved issues, report and propose to MSO Director and EZCAP Product Development team for resolutions
• Supports MSO audit activities performed by various entities, including contracted Health Plans, DHCS, and CMS
• Prepares other additional statistical reports to support decision making in managed care business development and to support operational initiatives and activities

Qualifications:

• Bachelor's degree from four-year college or university
• Knowledge of MS Word, Excel and basic medical terminology
• EZ-CAP knowledge; or equivalent combination of education and experience
• Excellent knowledge of CPT, HCPCS, ICD-10 CM, ICD-10 PCS, etc
• Ability to multi-task and meet deadlines
• Strong organization skills; ability to multitask and properly manage time
• Working knowledge of healthcare standard code sets, benefits, DOFR, RBRVS, and fee schedules
• Provider contract knowledge, including all kind of payment methods
• At least 2 year plus of claims processing experience in the health insurance industry or medical health care delivery system

Who We Are:

ApolloMed (NASDAQ: AMEH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise in order to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

Our platform currently empowers over 10,000 physicians to provide care for over 1.2 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise in order to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

Our Values:

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity and Excellence
• Be Innovative
• Work as One Team

Environmental Job Requirements and Working Conditions:

• Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 827 Pacific Ave, San Francisco, CA 94133
• The total compensation target pay range for this role is: $85,000 - $95,000. The salary range represents our national target range for this role.

ApolloMed is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.

Additional Information:

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.