What are the responsibilities and job description for the Rates Configuration Specialist position at MedPOINT Management?
Job Description SummaryUnder the general direction of the Provider Database Management & Rates Configuration, Sr Supervisor, the Rates Configuration Specialist 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 ResponsibilitiesCreate and maintain provider dictionaries and custom fee schedules based on contract termsMaintain Medicare and Medicaid fee schedulesAssign the appropriate fee schedules to providers including writing and determining hierarchy of conditions and exceptions to the primary fee schedule based on the terms of the provider's contractBuild and maintain all appropriate logs for fee schedules and fee set assignment implementationAuditing of EZ-CAP Providers / Vendor configuration (fee schedule, fee set assignments, etc.)Analyze root cause of errors; communicate errors to the appropriate MPM stakeholders and escalate EZ-CAP errors, issues, or problems to the department leadership and HIT teamsAssist PNO Network Management team and Field Representatives with provider concernsInterface with Benefits team and Claims team with questions / issues regarding provider configuration and reimbursementConduct per diem reporting, analysis and requestsSpecial projects, as neededMinimum Job Requirements3 years of Managed Care or Healthcare experience in Rate Configuration, Terms and Conditions, Reimbursement or Claims Auditing fieldEZ-CAP knowledge and experience requiredThorough understanding of ICD-9, CPT and HCPCS codes, Medicare and Medi-Cal fee schedules, RVUs and ASA reimbursementAdvanced knowledge of medical terminology and ability to read and interpret contracts and / or contract summariesIntermediate Proficiency in Microsoft Office Suite (Access, Word, Excel, PowerPoint, Outlook), Crystal Reports, SQLSubstantive knowledge of basic Internet terminology and functionalitySkills and AbilitiesStrong and consistent customer service acumen with the ability to resolve complaints and concernsExcellent attention to detail, with the ability to communicate and document information accuratelyProven ability to effectively analyze information and think criticallyAbility to multi-task, exercise excellent time management, and meet multiple deadlinesAbility to effectively and positively work in a dynamic, fast-paced team environment and achieve objectivesWillingness to take on and lead projects outside the normal scope of the job descriptionMedPOINT Management, a large MSO in the San Fernando Valley, offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com.#J-18808-Ljbffr
