System Configuration Coordinator

Independent Living Systems • Miami, FL

3d

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 System Configuration Coordinator helps ensure the accuracy, completeness, and appropriateness of claim determinations and payments. The role tests and reviews claims, including adjustments, to support accurate system configuration and efficient claims processing. It works with internal teams to validate system updates, analyze processing issues, and identify improvement opportunities. The coordinator also provides staff training and guidance to support consistent application of policies and procedures.

Requirements

• High school diploma or GED required; relevant experience may substitute for the educational requirement on a year-for-year basis.
• At least 2 years of experience in medical claims processing, medical billing, or as a call center advocate within a healthcare environment.
• Knowledge of UB04 and CMS1500 claims; ICD-10, Revenue, CPT, and HCPCS diagnosis and procedure coding; claim adjudication processes; and EDI and OCR claim submission.
• Ability to effectively and efficiently analyze data and summarize it in an organized and professional manner.

Nice To Haves

• Associate’s degree in Health Information Management, Information Technology, Computer Science, or a related field.
• Certified Professional in Healthcare Information and Management Systems (CPHIMS).
• Knowledge of database management.

Responsibilities

• Support testing of claim adjudication system programming, including benefit thresholds, authorization rules, and timely filing parameters.
• Assist with testing and validation of system modifications before migration to production.
• Review and analyze claims and adjustments to ensure correct pricing and identify root causes of processing errors.
• Identify trends and recommend policy or procedure changes to improve accuracy and performance.
• Provide guidance and support to staff on coding, edits, and policy application, and maintain quality data.

What This Job Offers

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