Senior Configuration Analyst

Location: Idlewild Ave, Tampa, FL 33634
Department: Operations - Configuration
Reports to: Sr. Manager, Configuration

The Senior Configuration Analyst is responsible for accurate and timely development of automated rules and pricing. This position will also need to help develop 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, fee schedules, contract loads as assigned
  • 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
  • Trains/monitors staff on contract pricing and contract templates
  • Ensures proper supporting documentation and maintains files for all price rules
  • Maintains all automated reports for assigned areas.
  • Builds and maintains positive business relationships with business partners
  • Loads contracts/fee schedules into the Peradigm System through appropriate research and provider data load activities
  • Monitor and develop automated provider loads into the Peradigm
  • Monitor and develop automated batch claims processing.
  • Works with management to identify, develop, and implement tools, applications, and reports focused on increased automation, improved load quality, and input/ throughput/output measurement.
    Candidate Education:
    • Required: High School or GED
    • Preferred: Bachelor's Degree in a related field
    Candidate Experience:
    • Required: 4 years of experience in analytics or related field
    Candidate Skills:
    • Knowledge of Claims Processing
    • Understanding of contract terms and how they are loaded into the system
    • Knowledge of provider/institutional billing practices
    • Knowledge of report automation
    • Ability to effectively research issues and resolve problems
    • Process orientation; understanding of process design and flow and associated analytical tools and techniques
      Technical Skills:
      • Xcelys
      • SQL Server System
      • Statistical Analysis Systems (SAS)
      • Microsoft Excel
      • Microsoft PowerPoint
      • Knowledge of CPT/HCPCS coding
      • Knowledge of database driven programs
      *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.