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Corporate Functions & Operations WellCare - Data Analyst Careers

Configuration Specialist Job

Full Job Title: Configuration Specialist

Job Number: 1703428

Location: Tampa, FL

Date Posted: 8-22-2017

Department: Operations -Configuration

Reports to: Operations Supervisor

Location: 5301 Idlewild Ave Tampa, FL 33634

To ensure accurate and timely loading of a provider contract, maintenance and termination processes through appropriate research.

Essential Functions:
  • Loads professional contracts into the Diamond System through appropriate research and provider data load activities.
  • Performs accurate and timely provider research, verification and analysis.
  • Resolves provider load issues within established documented processes.
  • Ensures the proper supporting documentation exists and is maintained on file for all load processes.
  • Loads and maintains provider data.
  • Loads new providers as a result of the approved Credentialing Committee Lists.
  • Coordinates with Membership for member move requests.
  • Assists in updating payable procedure codes, price rules and fee schedules.
  • Resolves critical errors forwarded from the claims department.
  • Updates tracking database.
  • Responsible for building and maintaining positive business relationships with business partners.
  • Assists in special projects.
  • Maintains high quality work.
  • Meets productivity expectations.
  • Works Auto Analyzer Reports.
  • Performs other duties as assigned.
Additional Responsibilities:Candidate Education:
  • Required A High School or GED
Candidate Experience:
  • Required 1 year of experience in Analytical Role
  • Preferred 1 year of experience in health insurance
Candidate Skills:
  • Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
  • Intermediate Other Basic understanding of contract terms and how they are loaded into the system
  • Intermediate Other General understanding of provider maintenance and termination processes
  • Intermediate Other Basic knowledge of provider billing practices
  • Intermediate Other Knowledge of claims processing
Licenses and Certifications:Technical Skills:
  • Preferred Intermediate Peradigm (Diamond)
  • Preferred Intermediate Other Cactus systems
  • Preferred Advanced Other Knowledge of Diamond provider/vendor files
Languages:

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Last Updated On: 12/9/2015