Configuration Specialist II

Job Number: 5169

Workplace Type: Fully Remote

Position Title: Configuration Specialist II

External Description:

Position Summary: The Configuration Specialist II determines configuration needed to meet the business requirements and configures the system to achieve a high level of accuracy and auto adjudication, as it relates provider contract pricing.  The Specialist II shall be responsible for analyzing building and maintaining all provider compensation within the managed care system ensure accurate claims payment consistent with contract and Medicare guidelines. General Duties/Responsibilities (May include but are not limited to): ·         Analyze provider contracts to determine the best approach for loading data elements into the Managed Care System. ·         Interpret provider contracts and build custom fee schedules, codifying contract terms into the fee schedules in the system ·         Load and maintain payment methodologies used by Alignment, within the managed care System as well as any external tools used within the organization. ·         Works assigned tickets timely and accurately ·         Monitors and assigns incoming Configuration and EDI Queue work orders ·         Manages user access and application performance as required ·         Ensure system is updated timely with Medicare Interest Rates ·         Assists with testing of new version releases of Managed Care System as they relate provider contracts ·         Assists with EDI related tasks to ensure timely and accurately uploading into managed care system. ·         Research and resolve claims issues as they relate to provider contract configuration   ·         Minimum Experience: a.       Minimum three (3) years of experience within Configuration. b.       Working knowledge of different payment methodologies which include but not limited to Medicare fee schedules, DRG, APC c.       General understanding of claims, referral authorizations and claims related code sets (i.e. HCPCS, CPT, revenue code, DRG, ICD codes)   ·         Education/Licensure: a.       High School Diploma or General Education Development (GED) required b.       Associate degree in related field, a plus ·         Other: a.       General understanding of medical terminology and claims processing b.       Logical thinking and understanding of relational database c.       Strong critical thinking and analysis skills d.       Excellent interpersonal, communication, and listening skills are required e.       EZ-Cap Experience f.        Proficient in MS Office Suite of products

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Configuration Specialist II

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].