1. Choose your Affinity Group

* Equal Opportunity / Affirmative Action

We serve Equal Opportunity Employers and are an Equal Opportunity Employer. The Professional Diversity Network has separate professional networking sites for different affinities, and in selecting the groups you identify with, you will be joined with those networks.

Note: Providing this information is strictly voluntary - you will not be penalized or subjected to adverse treatment. If you choose not to provide this information, simply select "Choose not to identify."

2. Choose Method
X
Sign in with LinkedIn
Sign in with Facebook
OR

Tell us about yourself

Configuration Analyst, Sr
at WellCare Health Plans
Tampa, FL

Configuration Analyst, Sr
at WellCare Health Plans
Tampa, FL

Save or bookmark jobs as you go and access them anytime later with your account.

Contacts

Description

Location: 5301 W Idlewild Ave, Tampa, FL

Reporting to: Supv, Configuration/Mgr, Configuration

Department: Ops-Configuration

The Senior Configuration Analyst is responsible for accurate and timely development of automated rules and pricing. This position will also need to help develop new business plans that will help promote technology and automation.

Essential Functions:

  • Builds rules within the Peradigm System, in coordination within State and Federal guidelines
  • Monitors and tests the accuracy of price rules, fee schedules, contract loads as assigned
  • Researches both State and Federal mandates and builds interpretation grids
  • Builds and tests contracts and pricing templates for the non-par and new business teams
  • Trains/monitors staff on contract pricing and contract templates
  • Ensures proper supporting documentation and maintains files for all price rules
  • Maintains all automated reports for assigned areas.
  • Builds and maintains positive business relationships with business partners
  • Loads contracts/fee schedules into the Peradigm System through appropriate research and provider data load activities
  • Monitor and develop automated provider loads into the Peradigm
  • Monitor and develop automated batch claims processing.
  • Works with management to identify, develop, and implement tools, applications, and reports focused on increased automation, improved load quality, and input/ throughput/output measurement.
Additional Responsibilities:

Candidate Education:

  • Required A High School or GED
  • Preferred A Bachelor's Degree in a related field
Candidate Experience:
  • Required 4 years of experience in analytics or related field
Candidate Skills:
  • Intermediate Other Knowledge of Claims Processing
  • Advanced Other Understanding of contract terms and how they are loaded into the system
  • Advanced Other Knowledge of provider/institutional billing practices
  • Advanced Other Knowledge of report automation
  • Intermediate Other Ability to effectively research issues and resolve problems
  • Intermediate Other Process orientation; understanding of process design and flow and associated analytical tools and techniques
Licenses and Certifications:
A license in one of the following is required:
    Technical Skills:
    • Preferred Intermediate Xcelys
    • Required Intermediate SQL Server System
    • Required Intermediate Statistical Analysis Systems (SAS)
    • Required Intermediate Microsoft Excel
    • Required Intermediate Microsoft PowerPoint
    • Required Intermediate Other Knowledge of CPT/HCPCS coding
    • Preferred Intermediate Other Knowledge of database driven programs
    Languages:

      About us
      Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

      Similar Jobs

      See All »

      Other Jobs at WellCare Health Plans

      See All »