Position: Contract Configuration Specialist
Salary Range:
Classification: Non-Exempt, Full-Time Reports to: Director – Contract Configuration - RCM
Summary/Objective This position is responsible for the successful implementation and support of the applications to include entering and maintaining billings plans and funding, systems and procesess to support the company’s billing department, troubleshooting all system application issues that arise from end users, and support medical/retail store operations.
Primary Functions
- Plan set up and configuration.
- Manually calculate claim allowable if applicable.
- Analyze multiple Client/Payer Contracts (Commercial, Managed Medicare/Medicaid, straight Governmental, and Workers' Compensation)
- Analyze all payer policies as they pertain to billing and system set up.
- Validate the accuracy of all payer contracts including language, and rates, and are loaded and priced accurately.
- Cross reference claims against fee schedules, contracted rates, payer policies, etc. to validate the system and claims are being paid based on contractual obligations.
- Requires a thorough understanding of the applications and related business processes assigned.
- Fully understands the purpose of each solution as it relates to the business's strategic direction.
- Requires an understanding of the features of each system, including their core responsibilities and how they utilize each solution for their specific job requirements.
10. Requires an understanding of insurance carriers to support internal workers to resolve issues during the day. 11. Support external resources through the various companies from plan designs, insurance inquiries, and billing support issues. 12. Day- to- day support of practice locations. 13. Application configuration, testing, and support
Supervisory Responsibility This position has no supervisory responsibilities.
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk.
This is largely a sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stoop as necessary. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds.
Travel Some travel maybe required
Minimum Qualifications/Requirements
- The ability to "train the trainers" and train individuals in unique circumstances.
- Requires an understanding of 837's and 835's.
- A high school diploma or GED
- Experience interpreting contracts that include rates, amendments, terminology, and the insurance industry process and procedures.
- Strong decision-making and problem-solving skills
- Familiarity with the CPTs, HCPCs, ICD-10, and CMS 1500 claim form
- Strong analytical and mathematical skills
- Prior experience with healthcare accounts receivables
- Understanding of managed care contracts
10. Proficient in Microsoft Excel, Word, PowerPoint, Outlook 11. Good to excellent spelling, grammar and written communication skills 12. Ability to analyze and resolve unpaid claims issues
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.
All qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, sexual orientation, gender identity or expression, disability, nationality or sex.
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