Medical Claims Specialist - Hybrid

Job Title: Configuration Analyst (33951024) – 2 positions

Location: Houston , TX 77401/ Hybrid

Job Type: 03 Months contract

Shift: Hybrid -M-F (8-5)

Duties: The configuration analyst should have strong knowledge in at least one of the areas under the purview of Med Policy

Configuration: benefits, contracting, coding, fees schedules, or claim edits (CES).

The Configuration Analyst role is responsible for the activities related to system updates, new health plan implementations

and conversions within Business Operations. Designs configurations solutions to meet new business requirements and performs

updates for either benefits, coding, contracts, fee schedules or claim editing rules in adherence with business policies and

state requirements.

• Analyzes incoming requests and designs configuration solutions to meet business requirements.

• Performs configuration changes for coding, contracts, benefits, fee schedules and claim editing rules as needed.

• Creates testing scenarios to demonstrate efficiency of proposed configuration solutions.

• Maintains thorough and concise documentation for tracking of all contract, benefit, fee schedule and claim editing rule changes related to Change Control Management or issues for quality audit purposes.

• Executes configuration changes in an accurate and timely manner to meet the department’s standards for quality andservice level agreements..

• Assists with the development of configuration standards and best practices.

• Identifies claims impacted by configuration changes done in the system and sends reports to the claims administration department for reprocessing.

• Monitors pended claims and work queues to update appropriate systems. Responsible for escalating identified issues,making recommendations and assisting with implementing configuration changes to improve accuracy and efficiency of process

• Handles fluctuating volumes of work and prioritizes work to meet deadlines and user needs of the Health Plan.

Skills: * Knowledge of current managed care business practices and adjudication systems used by the Health Plan.

• A working knowledge of the healthcare industry, preferably health insurance/managed care.

• Collaboration, written and verbal communication, detailed analytical and organizational skills; ability to manage time with

competing priorities; self-motivation; leadership; and ability to work independently with minimum supervision.

• Additional required knowledge includes: claims processing, configuration of contracts, benefits, fee schedules, and Claims

Editing System; ability to interpret business requirements into system coding edits, and testing of configuration builds.

• At least one EPIC Tapestry certification strongly preferred.

From a technical perspective it would be ideal that they have experience with the following three buckets:

-Experience in Texas Medicaid

-Claims Specialist or Claims Research Analyst experience

-Specifically experience working adjustments/appeals

-Tapestry Benefits or Tapestry Contracts configuration experience

-Tapestry Certifications in Contracts or Benefits.

Education: Required- H.S. Diploma or GED

Required- 2 years

Managed care, claims processing, and/or configuration

of benefits/contracts/fee schedules/medical policy

payment rules.

A Bachelor's degree may substitute for the required work experience.

Skills: Required

• MEDICAL CLAIMS

Job Type: Contract

Pay: $23.55 - $50.00 per hour

Schedule:

• Monday to Friday

Application Question(s):

• If interested, please leave your email, contact number and best time to reach you

Experience:

• Medical Claims: 3 years (Preferred)
• Texas Medicaid: 2 years (Preferred)

License/Certification:

• Tapestry Certification in Contracts or Benefits. (Preferred)

Work Location: In person

Salary : $24 - $50