Provider Configuration Analyst in Schenectady, NY

Position Summary: Works to effectively apply creative solutions to enhance business processes, regarding provider and pricing configuration. Promotes initiatives for process improvement, innovative thinking, and re-engineering. Works to address system gaps, provide workarounds, modifications, customizations and enhancements, with the current process. Implements and maintains capitation configuration. Implements and maintains contracts and pricing configuration, particularly RBRVS and other standard pricing methods, for both physicians and facilities. Investigates and provides solutions for daily production issues. Work claim queues to adjudicate and resolve claims issues. Performs other duties and assumes other responsibilities as assigned. Fosters positive working relationships with teammates and customers. Requirements: Bachelor s degree in information technology, health care or business preferred. Equivalent of related education and related experience may be considered. Experience with workflow tools, report generators, extract tools, such as Business Objects, Visio, required. Prior configuration experience using Trizetto Facets a must, AMISYS is strongly preferred. 1-3 years progressive, exempt-level analytical experience within managed care process area required. Experience within the claims adjudication and/or medical management processes required, within AMISYS or Facets preferred. Knowledge of medical terminology and CPT, HCPC, ICD-9-CM, and Revenue Coding systems. Basic knowledge of capitation, risk sharing, physician, hospital and facility provider reimbursement methodologies. Knowledge of Microsoft Office applications, particularly Access required. Superior skills in process analysis, system documentation, and workflow definition. Strong skills required in critical thinking, problem analysis, verbal and written communication, interpersonal interactions (eg, partnering, conflict management, consulting, mentoring), and team building required. Must be comfortable working in a team environment as well as independently, and possess a sense of accountability and urgency in completing assignments. Two years progressive work experience in medical and hospital coding process. Required Skills: FACETS, AMISYS, TRIZETTO, MEDICAL, HEALTH, HEALTHCARE, HEALTHCARE COMPANIES, MANAGED CARE, CLAIMS, CONFIGURATION, CONFIGURING, CONFIGURE, CONFIGURED, CONFIGURATOR To Apply to this job go to http://www.GadBall.com or click here