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Wellcare

Senior Configuration Specialist

Wellcare - Tampa, FL

Essential Functions: Loads all institutional or professional contracts into the Diamond System through appropriate research and provider data load activities. Performs accurate and timely provider research, verification and analysis. Resolves provider load issues within established documented processes. Ensures the proper supporting documentation exists and is maintained on file for all load processes. Creates and updates payable procedure codes, price rules and fee schedules needed for Participating contracts. Develop and maintain project plans for new business implementation (institutional only). Researches both State & Federal mandates and builds State interpretation grids. Creates and maintains price rules and fee schedules in coordination within State and Federal guidelines. Monitors and tests the accuracy of price rules and fee schedules. Create and maintain SATs as needed. Resolves critical errors forwarded from the claims department. Updates tracking database. Builds and maintains positive business relationships with business partners. Loads and maintains provider data. Maintains high quality work. Maintains productivity expectations. Runs and manipulates data on Auto Analyzer Reports. Reviews hospital or provider contracts to ensure they can be administered. Communicates with Provider Relations when contracts can not be administered properly. Assists in special projects Qualifications Candidate Education: Required: High School Diploma or GED Candidate Experience: Required: 2 years experience in health insurance Preferred: 1 years experience in end-to-end configuration Additional Skills:\u00a0 \u00a0 Understanding of contract terms and how they are loaded into the system Understanding of provider maintenance and termination processes Knowledge of institutional\/provider billing practices Knowledge of claims processing Technical Skills: Peradigm (Diamond) Knowledge of Diamond and Cactus systems Knowledge of CPT\/HCPCS coding *LI-JC1

18 days 18 hours ago

Wellcare

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Senior Configuration Specialist Wellcare - Tampa, FL, United States

   

Location: Tampa, FL

Company Profile:
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.