Configuration Specialist - Contract Build II

Centivo is looking for a Configuration Specialist - Contract Build IIto join our team!

You will be responsible to work with the Network and Provider Relations team to interpret contract pricing for the Centivo provider network and configuring the contract in Centivo's pricing platform for claim pricing and adjudication. This includes configuring the pricing mechanism and/or fee schedule in Centivo's pricing platform, working with Centivo's Network Contracting and Provider Relations team to ensure the appropriate fees are applying to claims, working with pricing vendors and building fee schedules. You will coordinate with all business units and external vendors during client implementations and/or conversions to determine requirements. You will ensure that interfaces between internal systems and vendor interfaces meet client needs as well as operational processes.

What you'll do:

• Interpret new and existing contract pricing configuration in the Centivo pricing platform to perform all client and claims administration based on product design, functionality and perform test validation as needed.
• Identify contracts that cannot be configured in Centivo's pricing platform and work with external pricing vendors to perform the necessary steps in getting the contract built into their system accurately.
• Collaborate with the Network Management, Provider Relations and Claims team when contracts are built or corrected to ensure updates are made in all systems pertaining to contracted providers.
• When contract accuracy is in question, analyze claim impact reports to determine if claims priced correctly.
• Complete claim adjustments based on provider disputes, requests from internal departments and as determined by analyzing Claim Impact reports.
• Complete configuration changes as identified, run and evaluate claim adjustment reports within Centivo's claim platform and supporting systems.
• Perform unit and/or end user testing for new configuration, programming enhancements, new provider contracts, and software changes as necessary that affect claims adjudication rules.
• Participate in special projects as needed and act as a liaison with specified user areas to define business requirements and processes for project deployment.

You should have:

• 2-4 years of experience processing claims and/or interpreting and configuring contracts and fee rules for simple provider contracts based on defined pricing methodologies.
• Demonstrated ability to identify when platform limitations or capabilities require a contract to be sent to an external pricing vendor.
• Ability to perform contract reviews to determine accuracy in configuration and correct as needed.
• Ability to analyze claims for pricing accuracy against contract requirements.
• Knowledge of professional and institutional claims adjudication.
• Understands health insurance benefit administration in a Self-Funded environment.
• Coding knowledge and experience with CPT, HCPCS, ICD10, CDT, Revenue, DRG and other relevant medical and industry-standard codes.
• Exemplary customer service skills demonstrated by researching and resolving issues that are configuration related in a timely and accurate manner.
• Ability to work independently, problem-solve, and make decisions.
• Enjoy working in a fast-paced environment managing multiple issues with pressure of production schedules and deadlines.
• Work collaboratively and influence others to drive results across multiple functional teams.
• 2-4 plus years of experience in TPA and self-funding processes and system configuration
• Prior experience with a highly automated and integrated claim adjudication system, El Dorado-Javelina preferred but not required.
• High school diploma or GED; associate or bachelor's degree preferred.
• Proficiency in Microsoft Office applications and other web-based software applications and willing to learn new proprietary computer systems.

Centivo Values:

• Resilient – This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don't give up.
• Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon.
• Positive – We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive.