What are the responsibilities and job description for the Medical Claims Configuration Analyst position at CSTS Customer Service and Technology Solutions LLC?
Company Overview
Mirra Health Care and CSTS Customer Service and Technology Solutions LLC are a leading third-party administrator specializing in the healthcare sector. Our mission is to transform the healthcare experience by providing exceptional administrative support for insurance plans, including claims processing, customer enrollment, and compliance with federal regulations.
Summary
We are seeking a highly motivated Configuration Analyst to join the Mirra Health Care Operations team. The Configuration Analyst is responsible for the day-to-day operations of the configuration function, supporting benefit configuration, provider data management, and fee schedule updates. This role works closely with the Director of Claims and other departments to ensure system accuracy, regulatory compliance, and optimal operational performance.
Responsibilities
- Accurately load demographic data, contract rate changes, and fee schedules for both participating and non-participating providers and facilities.
- Adhere to strict confidentiality policies, the company Code of Conduct, and established regulatory and quality standards.
- Ensure provider configuration procedures align with internal protocols and meet all Medicare, federal, and state requirements.
- Create and maintain the department’s manuals, job aids, and workflow documentation.
- Manage and monitor the front-end and reconciliation processes of configuration activities on a daily basis.
- Act as a subject matter expert to ensure compliance with CMS guidelines.
- Prepare and distribute configuration-related reports (daily, weekly, monthly, quarterly, annually) to internal stakeholders.
- Monitor and update CPT and ICD codes within fee schedules and benefit configurations as they are released.
- Perform audits to validate accuracy in configuration processes and resolve identified discrepancies.
- Lead quality improvement initiatives and data trend analyses related to configuration.
- Research provider credentialing details to ensure compliance with Medicare guidelines.
- Maintain current W-9 documentation for all non-participating providers.
- Update NPI numbers and manage documentation using Microsoft Office and other relevant software tools.
- Collaborate with Credentialing, Provider Relations, Network Operations, and Claims teams to meet departmental productivity and timeliness goals.
- Identify and address system gaps, propose enhancements, and support workarounds to ensure accurate fee schedule configuration for claims processing.
- Oversee provider information management, contract configuration, and resolution of daily production issues.
- Process and enter data for non-participating providers and supervise rate adjustments for applicable medical conditions or experience-based scenarios.
- Use rating tools, clinical references, and case-specific information to support analytical tasks and complete work within deadlines.
Requirements
- Associate’s or Bachelor’s degree in Healthcare Administration, Information Systems, Business, or a related field preferred.
- Minimum of 2–4 years of experience in a healthcare configuration or claims environment.
- Strong understanding of healthcare coding, benefit design, provider contracting, and CMS regulations.
- Proficiency with Microsoft Office Suite and data management systems.
- Excellent analytical, communication, and organizational skills.
- Ability to work independently, manage multiple priorities, and meet strict deadlines.
- Proficient in medical terminology and record management systems.
If you're ready to make a difference in the healthcare industry and have a passion for optimizing processes, we invite you to apply for the Configuration Analyst position at Mirra Health Care today!
Job Type: Full-time
Pay: $20.00 - $22.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Work Location: In person
Salary : $20 - $22
