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Senior Contract Configuration Specialist - Full Time, Days(REMOTE)

Company: Prospect Medical Holdings, Inc.
Location: Orange
Posted on: June 23, 2022

Job Description:

Senior Contract Configuration Specialist - Full Time, Days We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve. The Senior Contract Configuration Specialist is responsible for creating, updating and maintaining provider dictionaries, vendor contracts, fee schedules, reading and interpreting contracts and/or contract summaries, and assigning fee schedules to providers. Responsible for creating, updating and maintaining capitation tables for capitated providers. Should also be able to create reports relating to Vendor Contracts, Fee Schedules or Dictionaries for audit or other purposes. Job Responsibilities/Duties Create and maintain provider dictionaries, custom fee schedules, vendor contracts and capitation based on contract terms. Assign the appropriate fee schedules to providers including writing and determining hierarchy of conditions and exceptions to the primary fee schedule based on the terms of the provider's contract. Build capitation schedules and assign capitation rates for capitated Primary Care and Specialist providers. Test claims to make sure claims are being processed correctly as per the contract terms. Maintain Medicare and Medicaid fee schedules. Create and maintain all appropriate logs for fee schedules and capitation agreements. Process PVA/PVAS and PFS claims within stated Service Level Agreements by making appropriate updates to provider dictionaries, vendor contracts and fee schedules. Create and support new and existing DBMS reports. Analyzes root cause of errors; communicates errors to the appropriate clients and escalates IDX errors, issues, or problems to the Business Unit Manager. Assists in the research and evaluation of additional IDX capabilities required in support of clients needs. Lead and mentor junior Contract Configuration Specialists and foster development of skills and knowledge. Support and participate in on-boarding and training of new Contract Configuration Specialists. Take responsibility for developing, managing & completing projects. Qualifications Minimum Education: Associate degree or 4 years degree preferred. Minimum Experience: Thorough understanding of ICD-9, CPT and HCPCS codes. Thorough understanding of Medicare and Medi-Cal fee schedules, RVUs and ASA reimbursement. Knowledge of medical terminology. Ability to read and interpret contracts and/or contract summaries. Knowledge of SQL, data structures or a programming language. Experience with IDX preferred. Minimum 2-3 years of related experience. Proficient in Windows environment with Microsoft Office Suite, including Word, Excel, and Access, Adobe. Proficient with Microsoft Outlook or other E-mail and scheduling products. Knowledge of basic Internet terminology and functionality. Req. Certification/Licensure: None. Employee Value Proposition Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive: Company 401K Medical, dental, vision insurance Paid time-off Life insurance Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol. Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm. For this reason, we require applicants to pass a screening for drug use as a condition of employment. This includes: alcohol, marijuana, cocaine, opiates and methamphetamines. How to Apply To apply for this role, or search our other openings, please visit click on a location to begin your journey to a new career with us! We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEOC is the Law: Keywords: Contract Manager, Proprietary Agreements, Teaming Arrangements, Interdivision Work Orders.

Keywords: Prospect Medical Holdings, Inc., Orange , Senior Contract Configuration Specialist - Full Time, Days(REMOTE), Other , Orange, California

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