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Network Configuration Processor at Independent Health Assoc., Inc. in Williamsville, New York

Posted in General Business 30+ days ago.

Type: Full-Time





Job Description:

Overview

The Network Configuration Processor shall be responsible to ensure that the reimbursement base is configured, implemented, and maintained in the claim payment systems (Healthrules) in support of the organization.........s objectives....  This will include at a minimum, fee schedule build, contract build and set up, and providing feedback on options to implement.

Qualifications


  • High School diploma or GED required.

  • Two (2) years of experience in network/provider operations and/or claims required.

  • Working knowledge of high volume/system configuration environment required.

  • Excellent communication and problem -solving skills required. Demonstrated ability to absorb and implement new concepts.

  • Strong analytical skills and time management skills.

  • Excellent verbal and written communication skills.

  • Working knowledge of medical terminology.

  • Ability to work with others in a team environment, using consultative decision -making techniques.

  • Ability to work outside of core business hours which may include nights, weekends and holidays.

  • Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Key Accountabilities
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A. Develop Hospital Contract Logic in core claims system
B. Interpret and implement negotiated contracts into core systems (DRG tables, fees, etc.)
C. Ensure consistent, accurate and timely information is communicated to all concerned parties by coordinating activities with the claims and servicing departments
D. Create, load, maintain, edit rate tables, and fee schedules as necessary
E. Coordinate with claims department to ensure accurate adjudication using developed contract logic
F. Build/Change provider reimbursement file
G. Liaison to IHA claims department for Intergroup pricing
H. Intergroup provider verification set up.
I. Validate Monthly Bases Loaded file and duplicate provider identification
J. Audit Fee schedule changes
K. Develop and maintain SOP.........s on all responsibilities
L. Attend meetings as needed
M. Test all upgrades

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant.........s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via their Career Worklet.