Healthcare Provider Configuration Analyst - Remote - Contract
The role will be for a company based out of Southern California. Provider experience would be beneficial. Contract role that can be extended after 3 months or be considered for conversion to a FTE.
Update and maintain IDX Provider dictionaries from multiple sources such as contracting change forms, return mail and claims received from vendors not in IDX. All updates to be made with high degree of accuracy and speed.Update and maintain Vendor Contracts; custom fee schedules and capitation agreements 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. .Update and maintain Medicare fee schedules from CMS and CMS carrier web-sites. Update and maintain Medicaid fee schedules from Medicaid web-site.Manage and resolve timely claim queues for Provider edits (PVA - Pend Vendor Add) or Fee Schedule/rate inquiries (PFS - Pend Fee Schedule) by making appropriate updates in IDX.
Thorough understanding of ICD-10, CPT and HCPCS codes.Understanding of Medicare and Medi-Cal fee schedules, RVUs and ASA reimbursement. Ability to read and interpret contracts and/or contract summaries. Knowledge of SQL, data structures or a programming language. Experience with IDX preferred but not required. Proficient in Windows environment with Microsoft Office Suite, including Word, Excel, and Access, Adobe.
Please send your resume to Shawn Jen, Senior Technical Recruiter for immediate consideration. Let us help you secure an interview!
Irvine Technology Corporation (ITC) is an award-winning Information Technology Solutions and Staffing provider with roots in Southern California. For over fifteen years, we have had the privilege of serving exceptional client organizations as both a local and national resource. Our team is comprised of seasoned technologists, staffing industry thought leaders, top-notch recruiters, dedicated account executives, and a world class support staff.
Irvine Technology Corporation provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Irvine Technology Corporation complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities.
- Staffing Future LLC
- Category: Computer & IT
- Job type: Contract