Configuration Analyst

Independent Living Systems • Miami, FL

5d

About The Position

Independent Living Systems (ILS), along with its affiliated health plans Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for vulnerable populations. The Configuration Analyst helps ensure healthcare software systems and applications are configured accurately to meet organizational needs and regulatory requirements. The role analyzes system configurations, identifies improvements, and implements changes to enhance operational efficiency and data integrity. It collaborates with clinical, administrative, and IT teams to tailor configurations to member care workflows and compliance standards. Through detailed documentation and rigorous testing, the analyst helps ensure updates and implementations function within the healthcare environment and supports the technology infrastructure used for clinical and administrative processes.

Requirements

• High school diploma or GED required.
• At least two years of experience as a medical Senior Claim Examiner, Call Center Advocate, Business Analyst, or Trainer.
• Knowledge of UB04/CMS1500 claims; ICD-10, Revenue, CPT, and HCPCS diagnosis and procedure coding; claim adjudication processes; EDI and OCR claim submission; and Medicare and Medicaid reimbursement methodologies, including APR DRG, Exempt Units, APG, RBRVS, and APC.
• Ability to analyze data and summarize it effectively, efficiently, and in an organized and professional manner.
• Ability to read and interpret contracts and related documents.
• Ability to work in a fast-paced environment, prioritize workloads, and multitask to complete projects on time.
• Excellent verbal, written, and presentation skills.
• Proficiency in Microsoft Office, including Word, Excel, PowerPoint, and Access.
• Relevant education may substitute for the educational requirement on a year-for-year basis.

Nice To Haves

• Associate's degree in health care or a related field.
• Knowledge of UB04/CMS1500 claims; ICD-10, Revenue, CPT, and HCPCS diagnosis and procedure coding; claim adjudication processes; and EDI and OCR claim submission.
• Certification in Health IT or a related field, such as Certified Professional in Healthcare Information and Management Systems (CPHIMS).
• Knowledge of data analytics and reporting tools used in healthcare settings.
• Familiarity with project management methodologies and tools.
• Experience training and supporting end users in healthcare technology environments.

Responsibilities

• Test and process claims, including claim adjustments, and provide staff support and education as necessary.
• Troubleshoot and resolve provider records to support claims operations.
• Process claims in accordance with corporate policies and procedures and state regulations.
• Review and analyze claim samples, including auto-adjudicated claims, to ensure pricing follows contractual agreements, negotiated rates, or Medicaid and Medicare rates.
• Provide timely, consistent feedback to Management, individually and collectively.
• Participate in ad-hoc projects as necessary.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED