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Corporate Functions & Operations WellCare - Data Analyst Careers

Configuration Analyst Job

Full Job Title: Configuration Analyst

Job Number: 1804980

Location: Tampa, FL

Date Posted: 2018-07-16

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, Configuration

Department: Ops-config Production

Location: Idlewild Ave. Tampa, FL

Essential Functions:

  • 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.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    Candidate Experience:
    • Required 3 years of experience in analytics in a related field
    • Preferred Other Prior healthcare experience
    Candidate Skills:
    • 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
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Peradigm (Diamond)
      • Preferred Intermediate Other SAS or SQL
      • Required Intermediate Other Cactus systems
      • Preferred Intermediate Other Knowledge of CPT/HCPCS coding

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        Last Updated On: 12/9/2015