Department: Operations Configuration
Reports to: Configuration Manager
Location: 5301 West Idlewild Avenue, Tampa FL 33634
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