Contract Configuration Specialist- Part time

Imagine360

4d•Remote

About The Position

Imagine360 is seeking a Contract Configuration Specialist (Part Time) to join the team! The Part Time Contract Configuration Specialist will be responsible for affiliating new Tax IDs to contracts daily. These contracts are built and loaded into two different internal systems. This Specialist is also responsible for auditing and pricing of claims that require manual intervention, as needed, to ensure the pricing is correct. Additionally, any claims in different assigned hold queues are reviewed by the Specialist. Other Ad hoc responsibilities may include new fee schedule loading and audit of updates. Position Location: 100% remote

Requirements

High School Diploma or GED required
Knowledge and experience with medical contracts and medical insurance claims. Research oriented. Analytical and ability to multitask and manage time effectively.
Experience working in a managed care and health care environment and familiarity with Professional Provider and/or Facility reimbursements. Experience creating fee schedules.
Experience with contract loading systems which involve interpreting and programming reimbursement methodologies.
Understanding of complex provider contracts
Manual claim review pricing required
Knowledge of binding terms and provisions in a contract
Functional knowledge of payment methodology

Nice To Haves

College degree preferred
Medical coding experience is a plus
Medicare and Commercial reimbursement methodologies a plus

Responsibilities

Daily Tax ID (BASELoad) maintenance for affiliating new providers to Contracts in the internal systems.
Review and audit manual priced claims and ensure correct Direct Contract allowable is applied.
Work claims in assigned hold queues.
Audit and maintain yearly fee schedule updates as assigned.
Create and maintain provider roster additions, terminations and updates on assigned contracts.
Aid the Supervisor of Configuration Contracting as needed.
Field and respond to requests from internal teams on inquiries from providers, clients, brokers, and vendors.
Collaborate cross-functionally on any issues to ensure that provider needs are met, and issues are resolved.
Gather data for research, problem solving, and other miscellaneous purposes.
Produce, analyze, and disseminate reports as needed.
Perform clerical functions as assigned.
Provide timely and thorough follow to internal customers.
Appropriately escalate difficult issues up the chain of command.
Act as a role model in demonstrating the core values in customer service delivery
Participate in internal team meetings
Recognize and alert appropriate supervisors of trends that fall outside of quality parameters.
Perform self-quality monitoring to develop and execute plans to meet established goals.
Provide ongoing feedback to help optimize quality performance.