| NetworX Configuration Analyst || Remote|| W2 at Remote, Remote, USA |
| Email: [email protected] |
| From: Vishnu, Jupiter Technologies [email protected] Reply to: [email protected] Role : NetworX Configuration Analyst Exp : 3 Years+ Rate : 60k$ per annum on W2 location : Remote Bachelors degree in computer science or healthcare related field, or equivalent work experience Minimum 3-5 years experience in pricing configuration, preferably in Facets and NetworX Proficient in interpretation and analysis of provider contracts Proven ability to translate complex provider contracts into pricing configuration Demonstrated knowledge of pricing methodologies, including but not limited to Medicare and Medicaid, DRG, SNF, RBRVS, APC etc Job Responsibilities: The Medical Reimbursement Configuration Analysts works with our most complex pricing configuration Evaluates, designs, tests and performs configuration needed to meet the business requirements for contracts of the highest complexity, with a substantial variety of pricing methodologies including CMS, DRG, APC, Medicaid, RBRVS etc Assures end results achieve the highest levels of accuracy and claims auto adjudication Analyzes provider contracts for institutional and non-institutional providers, developing business requirements Analyzes pricing business requirements, develops and evaluates alternatives, prepares proposals and design specifications for complex configuration systems or applications to meet the identified needs, goals and metrics Configures and tests results, assuring that the highest levels of quality and claims auto adjudication are met Consults with Provider Contracting and/or Analytics to determine appropriate interpretation of contract intent Works with varying and complex pricing methodologies including, but not limited to, Medicare and Medicaid methodologies, Medicaid, DRG, APC, Outliers, RBRVS, Fee Schedules etc Designs and creates qualifiers within the system to assure appropriate services are priced at the correct rates Evaluates provider set up and works with Provider Data Maintenance team to assure that pricing and provider data are in synch Researches and resolves critical issues that are referred from Claims, Customer Service, Provider Relations, Credentialing, Analytics and Appeals Represents the unit on corporate and cross functional projects as assigned Attends software vendor subcommittee meetings to further knowledge and keep aligned with system changes and solutions Other duties as assigned Works with others at all levels throughout the organization including Provider Contracting, Claims, Customer Service, Benefit Configuration, IT, Data Analytics and others with frequently confidential information Works with outside vendors and staff at other health plans as needed to identify and vet ideas Office environment with extensive close PC and keyboard work, constant sitting, and phone work Keywords: information technology wtwo NetworX Configuration Analyst || Remote|| W2 [email protected] |
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| Thu Nov 07 18:48:00 UTC 2024 |