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Centivo · 2 days ago

Configuration Specialist - Pricing

United States

Full-time

Remote

Mid Level

$55K/yr - $60K/yr

3+ years exp

Centivo is an innovative health plan for self-funded employers focused on providing affordable healthcare solutions. The Configuration Specialist Pricing role is responsible for the accurate configuration and maintenance of provider contracts and pricing within Centivo’s systems, ensuring compliance with regulatory standards and supporting claims processing.

Health CareInformation TechnologyMedical

Responsibilities

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

Skilled in interpreting and implementing both new and existing contract pricing configurations within the Centivo pricing platform, ensuring comprehensive client and claims administration aligned with product design and functionality, and conducting necessary test validations

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

Qualification

Provider contract configurationClaims adjudicationPricing analysisCPT codingICD-10 codingAttention to detailAnalytical skillsCustomer serviceMicrosoft Office proficiencyProblem-solving skillsTeam collaborationCommunication skills

Required

Demonstrated ability to identify when platform limitations or capabilities require a contract to be sent to an external pricing vendor

Ability to perform contract reviews to determine accuracy in configuration and correct as needed

Ability to analyze claims for pricing accuracy against contract requirements

Exemplary customer service skills demonstrated by researching and resolving issues that are configuration related in a timely and accurate manner

Possess excellent analytical and problem-solving skills

Ability to work independently and as part of a team

Ability to multi-task and apply critical thinking skills

Strong attention to detail and accuracy

Enjoy working in a fast-paced environment managing multiple issues with pressure of production schedules and deadlines

Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others, including but not limited to reimbursement policy standards

Strong people skills, establishing rapport and working well with others

Preferred

3 years of experience in provider contract configuration, health plan claims process or a similar role preferred

In-depth knowledge of all claim components that influence pricing, including the requirements for UB and HCFA forms

Knowledge and experience in coding with Current Procedural Terminology (CPT), Healthcare Common Procedure Code System (HCPCS), International Classification of Diseases 10th Revision (ICD-10), Revenue and Diagnosis Related Groups (DRG), Current Dental Terminology (CDT), other relevant medical and industry-standard codes

Proficient in professional and institutional claims adjudication

Knowledge in health insurance benefit administration within a self-funded plan

The ideal candidate will have HealthRulesPayer (HRP) and HealthEdge Source (Source) experience

Knowledge of TPA and self-funding processes and system contract configuration is preferred

Advanced proficiency in Microsoft Office applications