• Configuration Specialist

    Job Locations US-CA-Fairfield
    Job ID
    2019-1474
    Category
    Configuration
  • Overview

    The Configuration Specialist is accountable for assisting in Configuration-related activities, responsible for maintenance and enhancement of system configuration and related database tables, documentation and support of PHC EDI related functions,testings, and assisting in documentation of changes to the system software configuration using a variety of computer software packages to meeting PHC needs.

    Responsibilities

     

    • Plan, program, test, and document new report applications to meet PHC needs; to maintain, correct, and modify existing reports using a variety of computer software packages.
    • Participate in the Medi-Cal OIL review process. Log, track, and report the status of open claim projects, open and closed OIL projects, and update the OIL logs as needed.
    • Maintain library of closed claim system configuration changes and enhancement projects.
    • Develop and maintain documents of claims custom logic for EDI; used to describe the information and logic in each field of each claim form for loading into the PHC claim system to ensure data integrity.
    • Work with IT and PR in developing Member/Provider look-up specifications to ensure claims are assigned to the correct member and provider to meet HIPAA compliancy.
    • Communicates and coordinates all system related changes with IT department.
    • Assist in documenting changes and enhancements to claim system configuration projects, goals, and outcomes of testing and processing guidelines and procedures.
    • Assist in researching Medi-Cal and PHC policy and programs related to assigned configuration projects.
    • Analyze, test, and make feasibility recommendations on impact of proposed system configuration enhancement work plans.
    • Participate in the research, review, and evaluation of new electronic claims provider submissions and communicate outcome to IT.
    • Completes and maintains configuration database on approved enhancement work plans, allowing for efficient and accurate claims processing for all lines of business in accordance with PHC benefits and pricing policies.
    • Maintain system rates and procedure/diagnosis code tables.
    • Maintain the NDC and UPN tables.
    • Maintain the EX code matrix for HIPAA compliancy for communication of claims outcome to providers on paper and electronic Remittance Advice.

    SECONDARY DUTIES AND RESPONSIBILITIES

    • Perform other duties as assigned.

    Qualifications

    Education and Experience

    Associates degree in related field preferred; Minimum two (2) years of healthcare claims examining experience. Experience with AMISYS Advance or other claims payment system, fee schedules, and procedure/diagnosis code tables preferred.

     

    Special Skills, Licenses and Certifications

    Knowledge of AMISYS Advance or similar claims payment system preferred. Understanding of claims processing requirements and ability to translate into systems change and reporting requirements preferred. Knowledge of Business Intelligence or other reporting software preferred. 

     

     

    Performance

    Based

    Competencies

    Excellent analytical skills to rationally resolve simple to moderate policy and technical problems. Excellent written and oral communication skills. Ability to present statistical and technical data in a clear and understandable manner. Ability to articulate technical concepts with both technical and non-technical peers and trainers. Excellent organization skills to work on multiple assignments simultaneously, prioritize work, and complete projects within established time frames.

     

     

    Work Environment And Physical Demands

    Ability to use a computer keyboard. More than 80% of work time is spent in front of a computer monitor. May be required to lift, carry, and move objects of varying size, such as computer print-outs, weighing up to 10 lbs.

     

     

     

    All HealthPlan employees are expected to:

    • Provide the highest possible level of service to clients;
    • Promote teamwork and cooperative effort among employees;
    • Maintain safe practices; and
    • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

     

    IMPORTANT DISCLAIMER NOTICE

     

    The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

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