Location: Idlewild Ave, Tampa, FL 33634
Department: Operations - Configuration Production
Reports to: Supervisor, Configuration
Ensures accurate and timely loading of the Institutional/ASC or professional provider contracts. Oversees the maintenance and termination processes through appropriate research.
- 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
- Required: High School Diploma or GED
- Required: 2 years experience in health insurance
- Preferred: 1 years experience in end-to-end configuration
- Understanding of contract terms and how they are loaded into the system
- Understanding of provider maintenance and termination processes
- Knowledge of institutional/provider billing practices
- Knowledge of claims processing
- Peradigm (Diamond)
- Knowledge of Diamond and Cactus systems
- Knowledge of CPT/HCPCS coding