This position is forCare1st Health Plan in Phoenix, a Wellcare Healthplans, Inc. company.
Oversees accurate and timely development of price rules and contract templates. Develops new business plans that will help promote technology and automation.
Reports to: Sr Mgr, Operations
Location: Camelback Rd, Phoenix AZ 85016
Job Type: Salaried/Exempt
- 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 A High School or GED
- Required 3 years of experience in analytics in a related field
- Preferred prior healthcare experience
- Advanced understanding of contract terms and how they are loaded into the system
- Advanced knowledge of provider/institutional billing practices
- Advanced ability to effectively research issues and resolve problems
- Intermediate knowledge of Claims Processing