Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)
The Contract Configuration Specialist supports network contracting teams and claims team through properly configuring contracts based on CMS/contract methodologies for accurate claims payment.
- Manage & configure contract reimbursement methodologies within specific time-frames into claims payment
- Partners with other departments to ensure appropriate data is collected and maintained
- Interprets and configures contract terms and claims coding in a risk based environment
- Understands health insurance benefit administration in a risk based environment
- Acts as a resource to other internal departments on contract issues
- Expected to meet or exceed departmental time-frames and quality metrics on a consistent basis
- Takes ownership of the work process, seeks ways to improve job and process efficiency and makes appropriate suggestions and solutions to management
- Ability to respond to inquiries from internal / external depts and providers in a timely manner
- Performs all other related duties as assigned
- High school diploma or GED
- 2+ years of experience with medical claims processing
- Knowledge of MS Word and Excel
- Experience managing multiple projects
- Proficient with Medicare processing guidelines, RBRVS, facility and ambulatory payment methodologies
- Undergraduate degree or higher
- Managed Care experience
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Claims Analyst, Claims Examiner, Claims Business Analyst, Contract Specialist, Contract Analyst, San Antonio, TX, Texas