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Configuration Specialist II

Company: Alignment Healthcare
Location: Orange
Posted on: May 27, 2023

Job Description:

Job Number: 5169

Position Title: Configuration Specialist II

External Description:

Position Summary: The Configuration Specialist II determines configuration needed to meet the business requirements and configures the system to achieve a high level of accuracy and auto adjudication, as it relates provider contract pricing. The Specialist II shall be responsible for analyzing building and maintaining all provider compensation within the managed care system ensure accurate claims payment consistent with contract and Medicare guidelines.

General Duties/Responsibilities (May include but are not limited to):
---Analyze provider contracts to determine the best approach for loading data elements into the Managed Care System.
---Interpret provider contracts and build custom fee schedules, codifying contract terms into the fee schedules in the system
---Load and maintain payment methodologies used by Alignment, within the managed care System as well as any external tools used within the organization.
---Works assigned tickets timely and accurately
---Monitors and assigns incoming Configuration and EDI Queue work orders
---Manages user access and application performance as required
---Ensure system is updated timely with Medicare Interest Rates
---Assists with testing of new version releases of Managed Care System as they relate provider contracts
---Assists with EDI related tasks to ensure timely and accurately uploading into managed care system.
---Research and resolve claims issues as they relate to provider contract configuration
---Minimum Experience:

a. Minimum three (3) years of experience within Configuration.

b. Working knowledge of different payment methodologies which include but not limited to Medicare fee schedules, DRG, APC

c. General understanding of claims, referral authorizations and claims related code sets (i.e. HCPCS, CPT, revenue code, DRG, ICD codes)

a. High School Diploma or General Education Development (GED) required

b. Associate degree in related field, a plus

a. General understanding of medical terminology and claims processing

b. Logical thinking and understanding of relational database

c. Strong critical thinking and analysis skills

d. Excellent interpersonal, communication, and listening skills are required

e. EZ-Cap Experience

f. Proficient in MS Office Suite of products

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Configuration Specialist II

Company Profile:

Alignment Health was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Health team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

EEO Employer Verbiage:

Alignment requires all new hires to follow local and/or state requirements regarding the COVID-19 vaccine and booster. If applicable, proof of vaccination and booster will be required as a condition of employment subject to legal exemptions. This policy, which Alignment reserves the right to modify, is part of Alignment's ongoing efforts to ensure the safety and well-being of its staff and community and to support public health efforts.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email [email protected].

Keywords: Alignment Healthcare, Orange , Configuration Specialist II, Other , Orange, California

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