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Contract Configuration Manager
Ref No.: 20-00240
Location: CA
Our client is currently recruiting for a Contract Configuration Manager that will report to the Director of IT, oversee the claims configuration and pricing, DOFR, and benefits set up within the claims payment system ensuring accurate reflection of provider contracts and claims payments.

  • Manage Contract Configuration and Benefits Analyst work assignment
  • Responsible for inventory, delegation and audit for the Contract Configuration and Benefits Department
  • Plan, manage, oversee and audit configuration ofFinancial Responsibility by LOB
    Fee Schedules by LOBModifier Set Tables
  • Component Unit Schemes by scheme name (RVUs Facility and Non-Facility)
  • Single Unit Schemes by scheme name (RVU Anesthesia Units)
  • Anesthesia Decimal Table and Set numbers (Related to units and time)
  • Incident Types, Subtypes and Action codes cross department Service Code Categories
  • Plan and manage configuration of Medicare, Medi-Cal fee schedules on a monthly and quarterly basis to include all states
  • Design and implement new Standard Operating Procedures (SOP) formally known as Policies and Procedures (P&Ps) Contract Configuration and Benefits Department
  • Assist and recommend in the development of process improvements including policies and procedures (P&P)
  • Ensures accuracy of Advanced Medical Management contract configuration through regular audits, comparisons, etc.
  • Ability to train, control, supervise and evaluate the performance of assigned personnel.
  • Serves as escalation point for configuration issues throughout Advanced Medical Management
  • Analyze situations accurately and adopt an effective course of action

  • Bachelor's degree in healthcare delivery or related field preferred.
  • Extensive managed healthcare experience of 10+ years in lieu of degree.
  • A minimum of five (5) years of progressive supervisory or managerial/leadership experience is required
  • A minimum of five (5) years hands on experience required in an IPA/Managed Care setting primarily within the Configuration Unit
  • Extensive knowledge and familiarity with operational workflows of configuration management and production management.
  • Experience with system configuration and interpretation is required
  • Must have experience with all lines of business, Medicare, Medi-Cal, and Commercial
    claims and know industry guidelines
  • Must understand Medical terminology, CPT, Revenue codes, ICD10, RBRVS, HCPCS,
    HIPPS code sets
  • Must be able to develop and manage project plans, estimates and implementations
  • Must be familiar with Microsoft Office (Word, Excel, Outlook)
  • Intermediate knowledge of writing SQL queries preferred
  • Strong interpersonal skills and ability to work effectively at all levels in a collaborative
    team environment
  • Ability to communicate effectively both orally and in writing
  • Knowledge of equipment operation related to a variety of computer/peripheral
    equipment, networks and their operation and related software applications
  • Experience with EZ-Cap configuration and operation preferred
  • Possess strong time management skills, including the ability to prioritize deadlines on
    multiple projects.
  • Produce accurate and high-quality work on time and consistently.
  • Ability to work in a fast-paced environment