Provider Configuration Analyst

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  • 20-00138
  • Full Time/Contract
  • Recruiting
  • Pasadena, CA
Job Description
POSITION TITLE
Provider Claims Configuration Analyst 

ESSENTIAL DUTIES & RESPONSIBILITIES

  • Build and maintain system accuracy and completion of all system changes including, health plan, RBRVS, Medicare, Medi-Cal, benefit options, financial responsibility.
  • Load provider configuration requirements in EZ-CAP to ensure claims pay correctly related to provider contracts, agreements, authorization and referrals
  • Interpret provider contracts, fee schedules and rates in order to set up configuration correctly to ensure providers are paid according to the source of truth(s)
  • Understanding and analyzing all types of agreements for system configurations; includes testing multiple claim scenarios.
  • Keeps manager informed about progress and problems.
  • Ability to work in a fast-paced, dynamic, rapidly changing environment.
  • Excellent oral and written communication skills.
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Minimum Experience/Knowledge:

  • Knowledge of 1500 and UB04 claims including CPT/REV/HCPCS and ICD-9/ICD-10 codes
  • Familiarity with medical terminology, CPT, and ICD-9 & ICD-10 coding
  • Claims adjudication and processing: 2 years (Required)
  • Minimum of 3 years of hands on experience with EZ-CAP
  • Proficiency in Microsoft Word, Excel, and Outlook

POSITION CLASSIFICATION 

  • Full Time
  • Compensation Commensurate with Experience

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