Contract Configuration Specialist

About us:

Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued. Please check out our company website at www.solishealthplans.com to learn more about us!

**Bilingual in English and Spanish is required**

Full benefits package offered on the first on the month following date of hire including: Medical, Dental, Vision, 401K plan with a 100% company match!

Our company has doubled size and we have experienced exponential growth in membership from 2,000 members to over 10,000 members!

Join our winning Solis Team!

Location: 9250 NW 36th Street, Ste. 400 Doral, FL 33178.

Position Summary:

The Contract Configuration Specialist is responsible for managing the process of setting up and maintaining contracts between healthcare providers and Solis Health Plans, Inc. including task of data entry, contract review and managing provider information, systems, and contracts. This role ensures that provider data is accurate and up to date in provider databases and claims, contributing to the integrity of the provider network. The specialist will handle the configuration of new provider contracts, updates to the active provider contracts, terminations and communication with providers regarding essential updates and notifications.

Essential Duties and Responsibilities:

Contract Management:

• Review, process and submit all credentialing applications and/or rosters received from the Network Prov Reps.
• Accurate input of provider details, service codes, reimbursement rates, demographic information and other pertinent contract information into system for all new individual providers and groups, including MSOs in the Company system
• Review and process all demographic changes, termination requests, pay to changes (W9) and fix any information that is NOT correct in the system (CORE) received from Provider Network team
• Manage updates to existing contracts as required
• Maintaining and updating provider network information within the system, including adding new providers, managing provider terminations, and addressing provider credentialing issues.
• Monitor credentialing activities to ensure contracts/providers statuses are updating in system, i.e., new providers, service locations, expired recredentialing, contract/provider terminations, etc.
• Notify PNA Representative or PR Reps when documents or information are missing.

Provider Information Maintenance:

• Update and verify provider information in claims and provider databases, with oversight of multiple data elements.
• Participate in conducting regular audits to ensure data accuracy and completeness.

Accuracy and Adequacy Reporting:

• Assist in review and analyze Accuracy Reports to identify and correct discrepancies.

Provider Communications:

• Send Welcome Letters, Termination Letters, and Re-credentialing Notifications to providers.

Provider Access Management:

• Facilitate and manage provider access to multiple internal applications and platforms.
• Provide support for resolving access-related issues.

Additional Responsibilities:

• Perform other administrative and configuration duties as assigned by management.
• Participate in process improvement initiatives to enhance provider data management efficiency.
• Collaborating with other departments within the organization, such as customer service, claims processing, and provider relations, to ensure that providers are meeting the needs of patients and the network.
• Identifying areas for improvement, setting targets, and implementing initiatives to achieve these targets.
• Maintaining accurate and up-to-date records of all providers within the network

Credentialing Support to include but not limited to:

• Review, process and send all credentialing applications and/or rosters that I received from the Network Prov Reps.
• Log all applications and carefully review to make sure that all required documents and information was received from PNA Representative or PRM.
• Create and enter in the system all new providers and Facilities data submitted in the applications or via rosters.
• Staying in touch with the Cred Department's coordinator for credentialing status requests from our providers and/or Solis staff members.

Qualifications and Education:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Experience:

• 2 years of experience in provider administration and configuration, healthcare data management, or a related role.
• Experience with healthcare claims processing, provider databases, or contract management is a plus.

Skills and Competencies:

• High level of accuracy and meticulousness when handling sensitive contract information.
• Strong attention to detail and accuracy in data management.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook).
• Familiarity with healthcare information systems and databases.
• Excellent organizational and time-management skills.
• Strong verbal and written communication skills.
• Ability to work independently on a variety of tasks and prioritize projects as part of a team.
• Problem solving and resolution skills
• Accurately interprets and applies departmental policies and procedures

What set us apart:

Join Solis Health Plans as a Contract ConfigurationSpecialist and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!

Job Type: Full-time

Pay: $20.00 - $24.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Ability to Commute:

• Doral, FL 33178 (Required)

Ability to Relocate:

• Doral, FL 33178: Relocate before starting work (Required)

Work Location: In person

Salary : $20 - $24