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Rates Configuration

Summary

Responsible for building and maintaining Provider fee schedules based on contract rates and terms. Ongoing rate evaluation, monitoring and testing.  Responsible for the accuracy of system set up for adjudication of contractual rates contractual language and terms. Works under the supervision of the VP, Network Operations and Manager Provider Services.


Duties and Responsibilities

  • Provider contract rate configuration
  • Fee schedule assignments
  • Per diem reporting, analysis and request
  • Assist claims and claims inquiry department with configuration concerns
  • Assist Field Reps with provider concerns
  • Auditing of EZ CAP Providers/Vendor configuration
  • Ongoing Fee schedule audits
  • Interface with Benefits, Claims, Provider Services with questions/issues regarding fee schedules
  • Run Ad-hoc reports, when requested

Minimum Job Requirements

High school diploma or GED; claims and coding experience.  EZ-CAP®knowledge required. Claims experience a plus.


Knowledge, Skills and Abilities Required:

  • Strong analytical skills.
  • Strong written and oral communication skills.
  • Ability to analyze, interpret and prepare reports.
  • Claims experience, as well as strong understanding of the Medi-Cal Fee Schedule
  • Proficiency with Microsoft Office Programs; primarily Excel 2013 or higher

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Job title: Rates Configuration

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