Location: Idlewild Ave, Tampa, FL, 33634
Department: Operations-Configuration Production
Reports to: Senior Manager, Configuration
Oversees accurate and timely development of price rules and contract templates. Develops new business plans that will help promote technology and automation.
- 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.
- Required: High School or GED
- Required: 3 years of experience in analytics in a related field
- Preferred: Healthcare industry experience
- 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
- Peradigm (Diamond)
- SAS or SQL
- Cactus systems
- Knowledge of CPT/HCPCS coding