Configuration Analyst

Location: Idlewild Ave, Tampa, FL 33634

Department: Operations - Configuration Production

Reports to: Sr. Manager, Configuration

Oversees accurate and timely development of price rules and contract templates. Develops new business plans that will help promote technology and automation.

Essential Functions:

  • Builds rules within the Peradigm System, in coordination within State and Federal guidelines.
  • Monitors and tests the accuracy of price rules.
  • Researches both State and Federal mandates and builds interpretation grids.
  • Builds and tests contracts and pricing templates for the non-par and new business teams.
  • Works with all regions on non-par documentation.
  • Trains/monitors staff on contract pricing and contract templates.
  • Resolves provider load issues within appropriate time.
  • Ensures proper supporting documentation and maintains files for all price rules.
  • Resolves critical errors forwarded from the claims department.
  • Builds and maintains positive business relationships with business partners.
  • Loads professional contracts into the Diamond System through appropriate research and provider data load activities.
Candidate Education:
  • Preferred: Bachelor's Degree in a related field
Candidate Experience:
  • Required: 3 years of experience in analytics in a related field
  • Preferred: 1 year of experience in healthcare
Candidate Skills:
  • Knowledge of Claims Processing
  • Advanced understanding of contract terms and how they are loaded into the system
  • Advanced knowledge of provider/institutional billing practices
  • Ability to effectively research issues and resolve problems
Technical Skills:
  • Peradigm (Diamond)
  • SAS or SQL
  • Knowledge of CPT/HCPCS coding

*LI-JC1

About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.