IEHP is looking to manage complex system configurations within their Business System, accurately interpreting state, federal, and contractual guidelines related to benefits, fee schedules, contracts, and business requirements.
Requirements
- Knowledge of Medicare and Medi-Cal fee schedules and benefit structure, and regulatory billing guidelines required
- Knowledge of CMS, DHCS, DMHC, NCQA rules and regulations preferred
- Extensive knowledge of CPT, HCPCS, Revenue, ICD10 coding rules and guidelines preferred
- Extensive knowledge of general managed care operations required; delegated plan model preferred
- Basic knowledge of relational database structure
- Advanced knowledge of Product System algorithms and processes preferred
- Familiar with basic medical product processing preferred
- Skilled in the use of Microsoft Excel and Access preferred
Responsibilities
- Assist with the development of configuration standards and best practice guides for maintaining efficiency, accuracy, automation and successful integration with internal and external systems and programs.
- Analyze and translate business specifications into detailed technical specifications based on system functionality and develop non-systematic workaround processes when necessary.
- Perform product system error root cause analysis.
- Track incoming requests and issue resolution through Microsoft Access, MediTrac, and Workfront tools.
- Identify and communicate impact of system enhancements or configuration changes on integrated systems and processes.
- Configure and maintain complex product related system builds with multi-tiered functionality and interrelated system dependencies, including but not limited to Contracts, Benefits, Fee Schedules, and Service Categories.
- Develop and maintain business requirements for the automation of coding updates.
Other
- Four (4) years of experience with the development and remediation of moderately complex system configurations, including capitated provider agreement configurations
- Bachelor’s degree from an accredited institution required
- Ability to work independently and solve complex problems with little to no assistance
- Ability to effectively manage multiple competing priorities
- Strong presentation and written communication skills
- Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval
