Senior Configuration Specialist

Location: Idlewild Ave, Tampa, FL 33634
Department: Operations - Configuration Production
Reports to: Supervisor, Configuration
Ensures accurate and timely loading of the Institutional/ASC or professional provider contracts. Oversees the maintenance and termination processes through appropriate research.
Essential Functions:
  • Loads all institutional or 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.
  • Creates and updates payable procedure codes, price rules and fee schedules needed for Participating contracts.
  • Develop and maintain project plans for new business implementation (institutional only).
  • Researches both State & Federal mandates and builds State interpretation grids.
  • Creates and maintains price rules and fee schedules in coordination within State and Federal guidelines.
  • Monitors and tests the accuracy of price rules and fee schedules.
  • Create and maintain SATs as needed.
  • Resolves critical errors forwarded from the claims department.
  • Updates tracking database.
  • Builds and maintains positive business relationships with business partners.
  • Loads and maintains provider data.
  • Maintains high quality work.
  • Maintains productivity expectations.
  • Runs and manipulates data on Auto Analyzer Reports.
  • Reviews hospital or provider contracts to ensure they can be administered.
  • Communicates with Provider Relations when contracts can not be administered properly.
  • Assists in special projects
Candidate Education:
  • Required: High School diploma or GED
Candidate Experience:
  • 2 years of experience in health insurance
  • 1 years of experience in end-to-end configuration
Candidate Skills:
  • Understanding of contract terms and how they are loaded into the system
  • Understanding of provider maintenance and termination processes
  • Knowledge of institutional/provider billing practices
  • Knowledge of claims processing
Technical Skills:
  • Microsoft Access
  • Peradigm (Diamond)
  • Knowledge of Diamond and Cactus systems
  • 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.