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Corporate Functions & Operations WellCare - Data Analyst Careers

Configuration Specialist Job

Full Job Title: Configuration Specialist

Job Number: 1805201

Location: Tampa, FL

Date Posted: 2018-07-27

Location: Idlewild Ave, Tampa, FL 33634
Department: Operations - Configuration Production
Reports to: Manager, Configuration

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.
    Candidate Education:
    • Required: High School Diploma or GED
    Candidate Experience:
    • Required: 1 year of experience in an analytical role
    • Preferred: 1 year of experience in health insurance
    Candidate Skills:
    • Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
    • Basic understanding of contract terms and how they are loaded into the system
    • General understanding of provider maintenance and termination processes
    • Basic knowledge of provider billing practices
    • Knowledge of claims processing
      Technical Skills:
      • Peradigm (Diamond)
      • Cactus systems
      • Knowledge of Diamond provider/vendor files
      *LI-JC1

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        Last Updated On: 12/9/2015