Configuration Specialist II

Location: Remote-US, California US

Notice

This position is no longer open.

Job Number: 4508

Workplace Type: Fully Remote

Position Title: Configuration Specialist II

External Description:

Alignment Healthcare is a consumer-centric platform delivering customized health care in the United States to seniors and those who need it most, the chronically ill and frail, through its Medicare Advantage plans. Alignment Healthcare provides partners and patients with customized care and service where they need it and when they need it, including clinical coordination, risk management and technology facilitation. Alignment Healthcare offers health plan options through Alignment Health Plan, and also partners with select health plans to help deliver better benefits at lower costs.

By becoming a part of the Alignment Healthcare team, you will provide Medicare enrolled consumers the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

Position Summary:

The Configuration Specialist II determines configuration needed to meet the business requirements and configures the system to achieve a high level of accuracy and auto adjudication, as it relates to code sets, reimbursement/pricing, division of financial responsibility (DOFR) and benefit administration.  The Specialist II shall be responsible for analyzing building and maintaining all provider contractual compensation within the Managed Care System.   Responsible for timely and accurately updating all standard and custom code sets utilized by Alignment within the Managed Care System. Collaborating with IT and Business to ensure accurate claims payment consistent with contract and Medicare guidelines.

 

General Duties/Responsibilities (May include but are not limited to):

·         Analyze provider contracts to determine the best approach for loading data elements into the Managed Care System.

·         Loads and maintains contractual requirements as they relate to reimbursement, division of financial responsibility (DOFR) and benefits into computer system.

·         Loads and maintains all standard code sets, including but not limited to CPT, HCPCS, ICD10 CM, ICD10 PCS, Revenue, HIPPS, Dental and Modifier Codes.

·         Loads and maintains all standard coding related to UB04 and CMS1500 form

·         Load and maintain all Medicare Payment methodologies used by Alignment, within the Managed Care System as well as any external tools used within the organization.

·         Load and maintain all custom codes used within Alignment, including but not limited to Adjustment, Processing Status and Managed Care System code sets.

·         Works assigned tickets timely and accurately

·         Monitors and assigns incoming Configuration and EDI Queue work orders

·         Manages user access and application performance as required (e.g.: HCIM; PCG; Optum 360)

·         Ensure system is updated timely with Medicare Interest Rates

·         Assists with testing of new version releases of Managed Care System as they relate to benefits, division or financial responsibility and pricing. 

·         Perform root cause analysis to resolve claims payment discrepancies and system or process inefficiencies.

·         Assists with EDI related tasks to ensure timely and accurately uploading into Managed Care System.

·         All other tasks assigned by Manager

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

·         Minimum Experience:

a.       Minimum two (2) years of experience within Configuration. General understanding of provider contracting and reimbursement, payment methodologies and fee schedules, claims, referral authorizations and code review.

 

·         Education/Licensure:

a.       High School Diploma or General Education Development (GED) required

·         Other:

a.       General understanding of medical terminology and claims processing

b.       Logical thinking and understanding of relational database

c.       General understanding of claims related code sets

d.       Familiar with Medicare Payment methodologies

e.       Knowledge of state and federal regulations

f.        Strong critical thinking

g.       Excellent interpersonal, communication, and listening skills are required

h.       EZ-Cap Experience

i.         Proficient in MS Office Suite of products

 

·         Work Environment:

    1. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

  • While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
  • The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].

City: Remote-US

State: California

Location City: Remote-US

Location State: California

Community / Marketing Title: Configuration Specialist II

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].