Imagine360 is seeking a Contract Configuration Specialist (Part Time) to join the team! The Part Time Contract Configuration Specialist will be responsible for affiliating new Tax IDs to contracts daily. These contracts are built and loaded into two different internal systems. This Specialist is also responsible for auditing and pricing of claims that require manual intervention, as needed, to ensure the pricing is correct. Additionally, any claims in different assigned hold queues are reviewed by the Specialist. Other Ad hoc responsibilities may include new fee schedule loading and audit of updates.\n
Position Location: 100% remote\n
Responsibilities include but are not limited to:\n\nDaily Tax ID (BASELoad) maintenance for affiliating new providers to Contracts in the internal systems.\nReview and audit manual priced claims and ensure correct Direct Contract allowable is applied.\nWork claims in assigned hold queues.\nAudit and maintain yearly fee schedule updates as assigned.\nCreate and maintain provider roster additions, terminations and updates on assigned contracts.\nAid the Supervisor of Configuration Contracting as needed.\nField and respond to requests from internal teams on inquiries from providers, clients, brokers, and vendors.\nCollaborate cross-functionally on any issues to ensure that provider needs are met, and issues are resolved.\nGather data for research, problem solving, and other miscellaneous purposes.\nProduce, analyze, and disseminate reports as needed.\nPerform clerical functions as assigned.\nProvide timely and thorough follow to internal customers.\nAppropriately escalate difficult issues up the chain of command.\nAct as a role model in demonstrating the core values in customer service delivery\nParticipate in internal team meetings\nRecognize and alert appropriate supervisors of trends that fall outside of quality parameters.\nPerform self-quality monitoring to develop and execute plans to meet established goals.\nProvide ongoing feedback to help optimize quality performance.\n\n
Experience\/Education:\n\nHigh School Diploma or GED required\nCollege degree preferred\nKnowledge and experience with medical contracts and medical insurance claims. Research oriented. Analytical and ability to multitask and manage time effectively.\nExperience working in a managed care and health care environment and familiarity with Professional Provider and\/or Facility reimbursements. Experience creating fee schedules.\nExperience with contract loading systems which involve interpreting and programming reimbursement methodologies.\n\n
Skills and Abilities: \n\nUnderstanding of complex provider contracts\nManual claim review pricing required\nKnowledge of binding terms and provisions in a contract\nFunctional knowledge of payment methodology\nMedical coding experience is a plus\nMedicare and Commercial reimbursement methodologies a plus\n\n
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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.\n
Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.\n
**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies\/business partners that have been invited to work on a specific role. Candidate Resumes\/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**\n