You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a Configuration Specialist responsible for creating, updating, and maintaining provider dictionaries, vendor contracts, and fee schedules. The role involves interpreting contracts, assigning fee schedules, and ensuring accuracy in system setup for claim adjudication. The Specialist will also create reports for audit needs and monitor rate evaluations.

Responsibilities / Job Duties

• Create and maintain provider dictionaries and custom fee schedules based on contract terms.
• Maintain Medicare and Medicaid fee schedules.
• Assign appropriate fee schedules to providers and determine hierarchy and exceptions based on contract terms.
• Build and maintain logs for fee schedules and fee set assignment implementation.
• Audit EZ-CAP Providers/Vendor configuration including fee schedules and assignments.
• Analyze root cause of errors and escalate issues to department leadership and HIT teams.
• Assist PNO Network Management team and Field Representatives with provider concerns.
• Interface with Benefits and Claims teams regarding provider configuration and reimbursement.
• Conduct per diem reporting and analysis.
• Participate in special projects as needed.

Minimum Education and Experience Qualification Requirements

Qualifications

• 3+ years of Managed Care or Healthcare experience in Rate Configuration, Terms and Conditions, Reimbursement, or Claims Auditing.
• EZ-CAP configuration knowledge and experience required.
• Thorough understanding of ICD-9, CPT, and HCPCS codes, Medicare and Medi-Cal fee schedules, RVUs, and ASA reimbursement.
• Advanced knowledge of medical terminology and contract interpretation.
• Intermediate proficiency in Microsoft Office Suite, Crystal Reports, and SQL.
• Substantive knowledge of Internet terminology and functionality.

Schedule / Shift

Monday - Friday 8am-5pm PST

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

Medix is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients