Contract Configuration Specialist

Imagine360 is seeking a Contract Configuration Specialist to join the team!  The Configuration Contracting Specialists will be responsible for implementing new and existing provider direct contracts. Primary functions will include loading the executed provider direct contracts into the claims and contract system, test loaded contracts and ensuring physician/health system contracts are being adhered to.

Position Location: 100% remote

Responsibilities include but are not limited to:

• Network Services Responsibilities

• Load and test of new or amended provider direct contracts across existing claims processing systems.

• Audit and maintain the setup of direct contracts, fee schedules or direct contract amendments.

• Track and implement annual direct contract rate updates as needed.

• Review and audit manual priced claims & ensure correct Direct Contract allowable is applied.

• Triage and handle (both Internally & Externally) any claims pricing inquiries related to direct contract programming and coordinate next steps across various departments for resolution.

• Adhere to standards for claims and direct contract loading turnaround timelines.

• Provide feedback on system limitations or expansion needs as a user of provider management database. Participate in any testing and validation of system changes and improvements.

• Assists others on contract build and maintenance including all testing functions for contracting.

• Create & maintain Direct Contract Provider Roster additions, terminations & updates.

• Special Projects as assigned.

• Contribute to quality improvement recommendations and develop documentation and training

• Reviews contracts for language compliance and rate discrepancies.

• Provides assistance with the RFP process.

• Identifies and recommends specific networks for clients' utilization and geographic area.

• Provides full overview of contracting efforts in an area.

• Administrative Duties

• Provides assistance to the Supervisor of Configuration Contracting as needed.

• Fields and responds to requests and inquiries from providers, clients, brokers, and vendors.

• Collaborates cross-functionally on complex issues to ensure that provider needs are met, and issues are resolved.

• Gathers data for research, problem solving, and other miscellaneous purposes.

• Produces, analyzes, and disseminates reports as needed.

• Performs clerical functions as assigned.

• Customer Service

• Provides timely and thorough follow up with staff, internal and external customers.

• Appropriately escalates difficult issues up the chain of command.

• Acts as a role model in demonstrating the core values in customer service delivery

• Provider direct guidance and support to internal and external customers for EBMS' cost containment strategies.

• Attends conferences and continuous education events.

• Quality Assurance

• Serves on committees, work groups, and/or process improvement teams to assist in improving quality/customer satisfaction.

• Recognizes and alerts appropriate supervisor of trends that fall outside of quality parameters.

• Performs self-quality monitoring in order to develop and execute plans to meet established goals.

• Provides ongoing feedback to help optimize quality performance.

• Collaborates with others and cross-departmentally to improve or streamline procedures.

• Develops new or improves current internal processes to improve quality.

Required Experience/Education:

• High School Diploma or GED

• College Degree

• Experience working in a managed care/ health care environment.

• Extensive Professional Provider and/or Facility reimbursement experience.

• Experience creating fee schedules.

• Experience with contract loading systems which involve interpreting and programming reimbursement methodologies

Skills and Abilities:

• Understanding of complex provider contracts

• Knowledge of binding terms and provisions in a contract

• Functional knowledge of payment methodology

• Medical coding experience is a plus

• Must be familiar with Medicare and Commercial reimbursement methodologies

What can Imagine360 offer you?

• Multiple Health plan options

• Company paid employee premiums for disability and life insurance

• Parental Leave Policy

• 20 days PTO to start / 10 Paid Holidays

• Tuition reimbursement

• 401k Company contribution

• Company paid Short & Long term Disability plus Life Insurance

• Professional development initiatives / continuous learning opportunities

• Opportunities to participate in and support the company's diversity and inclusion initiatives

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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**