Rates Configuration Specialist I

Under the general direction of the Lead, Rates Configuration Specialist, the Rates Configuration Specialist I 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. Should also be able to create reports relating to Vendor Contracts, Fee Schedules or Dictionaries for audit needs and ongoing rate evaluation, monitoring and testing. Responsible for the accuracy of system set up for adjudication of claims based on contractual language and rate terms. Duties and Responsibilities: Learn and understand the end-to-end process for creating and maintaining provider dictionaries and fee schedules based on contract terms. Assign appropriate fee schedules to providers, including exceptions, in accordance with provider contract terms. Build and maintain logs tracking fee schedule and fee set assignment implementations. Audit EZ-CAP provider and vendor configurations, including fee schedules and fee set assignments. Communicate errors to MPM stakeholders and elevate EZ-CAP issues to department leadership and HIT teams. Assist the PNO Network Management team and Field Representatives with provider concerns. Coordinate with the Benefits and Claims teams to resolve provider configuration and reimbursement issues. Support per diem reporting, analysis, and related requests. Understand and follow Employee Handbook policies and procedures. Ensure HIPAA compliance at all times. Perform other duties and assignments as needed. 2+ years of managed care or healthcare experience in rate configuration, terms and conditions, reimbursement, or claims auditing EZ-CAP experience required Strong understanding of ICD-9, CPT, HCPCS codes, Medicare and Medi-Cal fee schedules, RVUs, and ASA reimbursement Intermediate knowledge of medical terminology, with the ability to interpret contracts and summaries Proficiency with Microsoft Office Suite (Access, Word, Excel, PowerPoint, Outlook), Crystal Reports, and SQL Familiarity with basic Internet terminology and functionality Skills and Abilities: Strong customer service skills with the ability to resolve complaints and concerns Excellent attention to detail and accurate communication/documentation Proven analytical and critical thinking abilities Effective multi-tasking, time management, and ability to meet deadlines Ability to work positively in a dynamic, fast-paced team environment and achieve objectives Salary Range: $72,500 – $77,500 annually #J-18808-Ljbffr MedPOINT Management