Location: Idlewild Ave. Tampa, FL
Department: Ops-Provider Operations
Reporting to: Manager, Configuration
Oversees accurate and timely development of price rules and contract templates. Develops new business plans that will help promote technology and automation.
Additional Responsibilities:Candidate Education:
- 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 Other Prior healthcare experience
Licenses and Certifications:
- Intermediate Other Knowledge of Claims Processing
- Advanced Other Advanced understanding of contract terms and how they are loaded into the system
- Advanced Other Advanced knowledge of provider/institutional billing practices
- Advanced Other Ability to effectively research issues and resolve problems
A license in one of the following is required:
- Required Intermediate Peradigm (Diamond)
- Preferred Intermediate Other SAS or SQL
- Required Intermediate Other Cactus systems
- Preferred Intermediate Other Knowledge of CPT/HCPCS coding