Tech Stack

Description

You will be responsible for configuring and maintaining provider contract and pricing configurations within Centivo's core systems to support accurate claims adjudication and provider payments. This involves interpreting contract terms, setting up fee schedules, and ensuring compliance with regulatory standards while collaborating with various teams and vendors.

Requirements

• Demonstrated ability to identify when contracts need external pricing vendors
• Ability to perform contract reviews and correct configurations
• Ability to analyze claims for pricing accuracy against contracts
• Exemplary customer service skills for resolving configuration issues
• Excellent analytical and problem-solving skills
• Ability to work independently and as part of a team
• Ability to multi-task and apply critical thinking
• Strong attention to detail and accuracy
• Ability to work in fast-paced environment with production deadlines
• Excellent verbal and written communication skills
• Strong people skills and ability to establish rapport

Responsibilities

• Read and interpret physician, facility and ancillary contracts
• Perform manual pricing based on contract language interpretation
• Configure and maintain provider contracts in database systems
• Interpret and apply contract terms, fee schedules, and reimbursement methodologies
• Implement contract pricing configurations within Centivo's pricing platform
• Identify contracts incompatible with pricing platform and collaborate with external vendors
• Collaborate with Network Management, Provider Relations and Claims teams
• Analyze claim impact reports to verify pricing accuracy
• Complete claim adjustments based on disputes and analysis
• Complete configuration changes and evaluate claim adjustment reports
• Perform testing for new configurations, enhancements, contracts and software changes
• Participate in special projects and function as liaison for business requirements
• Provide technical support and training for team members