Configuration Specialist

Location: Idlewild Ave, Tampa, FL 33634

Department: Operations - Configuration Production

Reports to: Manager, Configuration

To ensure accurate and timely loading of a provider contract, maintenance and termination processes through appropriate research.

Essential Functions:

  • Loads professional contracts into the Diamond System through appropriate research and provider data load activities.
  • Performs accurate and timely provider research, verification and analysis.
  • Resolves provider load issues within established documented processes.
  • Ensures the proper supporting documentation exists and is maintained on file for all load processes.
  • Loads and maintains provider data.
  • Loads new providers as a result of the approved Credentialing Committee Lists.
  • Coordinates with Membership for member move requests.
  • Assists in updating payable procedure codes, price rules and fee schedules.
  • Resolves critical errors forwarded from the claims department.
  • Updates tracking database.
  • Responsible for building and maintaining positive business relationships with business partners.
  • Assists in special projects.
  • Maintains high quality work.
  • Meets productivity expectations.
  • Works Auto Analyzer Reports.
  • Performs other duties as assigned.
Candidate Education:
  • Required: High School or GED
Candidate Experience:
  • Required: 1 year of experience in an analytical role
  • Preferred: 1 year of experience in health insurance
Candidate Skills:
  • Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
  • Basic understanding of contract terms and how they are loaded into the system
  • General understanding of provider maintenance and termination processes
  • Basic knowledge of provider billing practices
  • Knowledge of claims processing
Technical Skills:
  • Peradigm (Diamond)
  • Cactus systems
  • Knowledge of Diamond provider/vendor files

*LI-JC1

About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. 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.