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Contract Configuration Specialist *Partially Remote*

Company: Apollo Medical Holdings, Inc.
Location: Monterey Park
Posted on: November 17, 2022

Job Description:


The Contract Configuration Specialist will understand the types of provider contracting arrangements and/or benefits administration data elements that need to be configured in the existing application and other platform applications to support the accurate & timely payment of claims for the Regions' Claims systems. Test new releases, make recommendations on system enhancements, and evaluates contracts for configuration which includes system capabilities. Consults with appropriate internal partners on issues and interpretations. Works with Manager & Supervisor to define, code, configure and maintain detailed provider services. The specialist should clearly understand the products and healthcare benefits services offered to our customers, including cost share, limits and regulatory rules and guidelines.


* Performs configuration activities which may include provider contracts, fee schedule, and DOFR
* Ensures the provider authorization & benefits configuration meets established business rules & procedures
* Loads new/updated payor and payee contracts, amendments, fee schedule, locality, ICD-9 and ICD-10, procedure codes, and revenue codes into EZ-CAP
* Monitor contract updates & contract(s) matrix
* Test and audit claims payment accuracy against contract information loaded into EZ-CAP
* Consults with relevant Claims Manager, Contract Manager, and Business Analyst to determine appropriate interpretation & configuration of contract terms
* Maintains detailed knowledge & understanding of EZ-CAP rules relative to claims payment
* Develops, documents & executes test plans for configuration testing & validate accuracy of data loaded
* Coordinates research & resolution of debarred & sanctioned providers & ensures communication of required system updates to Provider Contracting & Claims operations
* Add PCF (Provider Can't Find) into EZ-CAP. Verify W-9, NPI, Taxonomy codes, class codes, & Specialty codes
* Assume other duties as directed


Keywords: Apollo Medical Holdings, Inc., Monterey Park , Contract Configuration Specialist *Partially Remote*, Other , Monterey Park, California

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