Contract Configuration Specialist

Job Summary:
Is responsible for creating, updating and maintaining fee schedules, reading and interpreting contracts and/or contract summaries, assigning fee schedules to providers. Responsible for creating, updating and maintaining capitation tables for capitated providers.

The following job functions are included, but not limited to:

• Ensure the privacy and confidentiality of all patient information and strictly adhere to all company policies
• Load and maintain custom fee schedules based on contract terms
• Assign the appropriate fee schedules to providers including writing and determining hierarchy of conditions and exceptions to the primary fee schedule based on the terms of the provider's contract
• Build capitation schedules and assign capitation rates for capitated Primary Care and Specialist providers
• Prepare AB1455 letters and create fee schedule files for AB1455 notifications
• Assist in meeting compliance issues for state and federal guidelines
• Other duties as assigned

Requirements and/or Qualifications:
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.

• Thorough understanding of ICD-9, CPT and HCPCS codes required
• Thorough understanding of Medicare and Medi-Cal fee schedules, RVUs and ASA reimbursement
• Knowledge of medical terminology
• Ability to read and interpret contracts and/or contract summaries
• Some programming skills helpful
• Must be knowledgeable in the use of Microsoft Excel and Microsoft Access
• Experience with IDX preferred
• Ability to type 40 wpm and ten key by touch

Education and/or Experience:

• High School diploma or equivalent. Some college level courses preferred.
• Two to three years experience in a health care environment preferably with fee schedules and/or advanced claims adjudication experience

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If you are interested in any of the above positions, please send your resume and salary history to: hr@prospectmedical.com. Also please include the job title in the subject line.