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Corporate Functions & Operations WellCare - Data Analyst Careers

Configuration Specialist Job

Full Job Title: Configuration Specialist

Job Number: 1804342

Location: Tampa, FL

Date Posted: 2018-07-31

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

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        Last Updated On: 12/9/2015