Health Plan Configuration Analyst is responsible for configuring benefit tables and payment/fee schedules in the claims adjudication system. Interface with department managers regarding system changes.
Minimum of associates' degree, bachelor's preferred, or equivalent experience in healthcare claims adjudication logic, database maintenance and project management.
Must have knowledge of CPT, ICD-9/ICD-10, HCPCS, Revenue Codes and pricing methodologies.
Minimum of 2-3 years Health Care industry knowledge and operations (example: claims processing, enrollment, provider file maintenance) with ability to interpret and document business requirements.
Demonstrated ability to process health care claims and to understand claim life cycle.
Strong analytical skills and problem solving skills.
Understanding of core processing systems in relation to configuration set-up.
Demonstrated understanding of working with government agencies such as CMS, Medicaid, etc. along with interpreting agency and contract requirements.
Strong computer skills with proficiency in MS Word, Excel, Outlook, and Access.
SQL experience preferred.
Excellent communication skills both verbal and written.