Job Summary

Configuration Manager

  • Location:
    Delray Beach, Florida
  • Salary:
    80000 $ - 90000 $ / Year
  • Job reference:
  • Category:
    Content/Document Management
  • Contract Type:
    Direct Hire

Job Summary:  Responsible for programming all Health Plan benefits in to the Claims Administration system (Plexis). If you have experience with TriZetto and Qnxt will work – knowledge is transferable.
This candidate will manage a team of 3.
Responsibilities include: inputting fee schedule, must have strong knowledge of claims, loading new providers, loading new code.Will be working on claims platform- so needs to be very structured and pay great attention to detail when Adding rates and Financial burdens.
Essential Job Responsibilities:
• Create benefit plans, load contract data and update Medicare/Medicaid fee schedules.
• Configuration responsibilities also include benefit and claim testing.  
• Analyze and interpret various Health plan contracts.
• Configure capitated, FFS, and Pass-Thru contracts as applicable based on the Health Plan.
• Load and modify Provider and network data in the claims system.
• Partner with IT to assign and reassign both membership and providers in the event of physician contract changes.
• Partner with claims to identify and resolve issues relating to claims caused by configuration.
• Partner with provider services to identify and resolve issues relating to service.
• Adding new Health Plan contracts and program changes as needed.
• Load Health Plan benefits into the claims system each new calendar year.
• Build / create system structure related to fee schedule selection, including the loading of actual fee schedules.
Other Job Responsibilities:
• Contributing to the team effort by accomplishing additional responsibilities as needed.
**To perform this job successfully, an individual must be able to perform the essential job responsibilities satisfactorily.  Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.
Knowledge/Experience Requirements:
• 5 years’ experience with Health Plans
• 5 years Claim processing experience
Specific Job requirements:
• Able to be self-directed, prioritize daily work, multi-task and meet tight deadlines
• Comprehensive knowledge of all Microsoft Office applications, including Word and Excel
• Excellent written and verbal communication skills
Physical Demands:
• Use a PC, computer and/or telephone over five hours a day
• Ability to communicate in an active office environment
• Ability to operate all required job related equipment
• Ability to sit for 75% or more during an 8 hour workday
• Occasional long, irregular hours

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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

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