Configuration Specialist - Pricing

The Configuration Specialist Pricing role is responsible for the accurate and timely configuration and maintenance of provider contract and pricing configurations within Centivo’s core systems.

Requirements

• Ability to read and interpret new and existing physician, facility and ancillary contracts.
• Perform manual pricing based on accurate interpretation of contract language.
• Configure and maintain provider contracts in the health plan’s database systems.
• Interpret and apply contract terms, fee schedules, and reimbursement methodologies.
• Identify contracts that are incompatible with Centivo’s pricing platform and collaborate with external pricing vendors to ensure accurate integration of these contracts into their systems as needed.
• Collaborate with the Network Management, Provider Relations and Claims team when contracts are built or corrected to ensure updates are made in all systems pertaining to contracted providers.
• When contract accuracy is in question, analyze claim impact reports to determine if claims are priced correctly.
• Complete claim adjustments based on provider disputes, requests from internal departments and as determined by analyzing Claim Impact reports.
• Complete configuration changes as identified, run, and evaluate claim adjustment reports within Centivo’s claim platform and supporting systems.
• Perform unit and/or end user testing for new configuration, programming enhancements, new provider contracts, and software changes as necessary that affect claims adjudication rules.
• Participate in special projects as needed and function as a liaison with specified user areas to define business requirements and processes for project deployment.
• Provide technical support and training for other team members as needed.