Job Details

Summary

Under the general direction of the Provider Database Management & Rates Configuration, Sr Supervisor, the Rates Configuration Coordinator is responsible for updating and maintaining provider dictionaries, vendor contracts, fee schedules, reading and interpreting contracts and/or contract summaries, assigning fee schedules to providers, and creating the capitation tables for all capitated providers. The candidate should also be able to create reports relating to Vendor Contracts, Fee Schedules or Dictionaries for audit needs and ongoing rate evaluation, monitoring and testing. The Rates Configuration Coordinator is also responsible for the accuracy of system set up for adjudication of claims based on contractual language and rate terms.

Duties and Responsibilities

· Learns and understands end-to-end process of creation and maintainence of provider dictionaries and fee schedules based on contract terms

· Assigns the appropriate fee schedules to providers including exceptions to the primary fee schedule based on the terms of the provider's contract

· Learns and maintains all appropriate logs for fee schedules and fee set assignment implementation

· Auditing of EZ-CAP Providers/Vendor configuration (fee schedule, fee set assignments, etc.)

· Creates capitation tables to facilitate the capitation assignment to all associated providers

· Works closely with HIT and Finance to ensure the accuracy and maintenance of all provider capitation configuration

· Communicates errors to the appropriate MPM stakeholders and escalates EZ-CAP errors, issues, or problems to the department leadership and HIT teams

· Assists PNO Network Management team and Field Representatives with provider concerns

· Interface with Benefits team and Claims team with questions/issues regarding provider configuration and reimbursement

· Assists with per diem reporting, analysis and requests

Minimum Job Requirements

· 1+ years of Managed Care or Healthcare experience in Rate Configuration, Terms and Conditions, Reimbursement or Claims Auditing field

· EZ-CAP knowledge and experience required

· Thorough understanding of ICD-9, CPT and HCPCS codes, Medicare and Medi-Cal fee schedules, RVUs and ASA reimbursement

· Intermediate knowledge of medical terminology and ability to read and interpret contracts and/or contract summaries

· Intermediate-level in Microsoft Office Suite (Access, Word, Excel, PowerPoint, Outlook), Crystal Reports, SQL

· Substantive knowledge of basic Internet terminology and functionality

Skills and Abilities

· Strong and consistent customer service acumen with the ability to resolve complaints and concerns

· Excellent attention to detail, with the ability to communicate and document information accurately

· Proven ability to effectively analyze information and think critically

· Ability to multi-task, exercise excellent time management, and meet multiple deadlines

· Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives

MedPOINT Management, a large MSO in the San Fernando Valley, offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmangement.com.