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Corporate Functions & Operations WellCare - Data Analyst Careers

Configuration Specialist - Senior Job

Full Job Title: Sr. Configuration Specialist (Institutional)

Job Number: 1704244

Location: Tampa, FL

Date Posted: 10-2-2017

LOCATION: 5301 W. Idlewild Avenue, Tampa, FL 33634
DEPARTMENT: Operations,Configuration Production
REPORTING TO: Supervisor, Configurations
Ensures accurate and timely loading of the Institutional/ASC or professional provider contracts. Oversees the maintenance and termination processes through appropriate research.
Essential Functions:
  • Loads all institutional or 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.
  • Creates and updates payable procedure codes, price rules and fee schedules needed for Participating contracts.
  • Develop and maintain project plans for new business implementation (institutional only).
  • Researches both State & Federal mandates and builds State interpretation grids.
  • Creates and maintains price rules and fee schedules in coordination within State and Federal guidelines.
  • Monitors and tests the accuracy of price rules and fee schedules.
  • Create and maintain SATs as needed.
  • Resolves critical errors forwarded from the claims department.
  • Updates tracking database.
  • Builds and maintains positive business relationships with business partners.
  • Loads and maintains provider data.
  • Maintains high quality work.
  • Maintains productivity expectations.
  • Runs and manipulates data on Auto Analyzer Reports.
  • Reviews hospital or provider contracts to ensure they can be administered.
  • Communicates with Provider Relations when contracts can not be administered properly.
  • Assists in special projects
Education: High School Diploma required
Experience: 2-4 years experience in health insurance required
1 years experience in end to end configuration
Special Skills (e.g. 2nd language): Strong understanding of contract terms and how they are loaded into the system
Strong understanding of provider maintenance and termination processes
Good knowledge of institutional/provider billing practices
Technical Skills/Requirements: Knowledge of Claims Processing
Knowledge of CPT/HCPCS coding
Knowledge of Access sufficient to pull queries related to provider loads, price rules, and claims processing
Knowledge of Diamond and Cactus systems
In-depth knowledge of Diamond provider/vendor files

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Last Updated On: 12/9/2015