Configuration Analyst jobs in Miami, FL

 ABOUT US

Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.

Position Summary

The Configuration Analyst is responsible for assuring the accuracy, completeness and appropriateness of claim determinations and payments as well as adding, maintaining, and updating provider data records within the company's proprietary claim system.                                                                                                          

Essential Functions 

1. Claims testing and processing including claim adjustments, as well as providing support and education to the staff as necessary. 
2. The incumbent will troubleshoot and resolve provider records to support the claims operation. 
3. Process claims in accordance with corporate policies and procedures and state regulations. 
4. Review and analyze a variety of claim samples including auto-adjudicated claims to assure pricing per contractual agreement, negotiated rate or to Medicaid and Medicare rates.
5. Provide consistent feedback to Management in a timely manner both individually and collectively.
6. Participate in ad-hoc projects as necessary.
7. Ability to read and interpret contracts and other related documents required.
8. Function in a fast-paced environment that requires prioritizing workloads and multi-tasking to complete projects on time.
9. Team player that can work well independently and make decisions without excessive supervisory oversight.
10. Excellent verbal, written and presentation skills required.
11. Proficiency in Microsoft Office (Word, Excel, PowerPoint, and Access) required.

Education and Experience

• High School diploma/ GED required; college course work preferred. 
• Minimum two (2) years' experience as a medical Senior Claim Examiner, Call Center Advocate, Business Analyst or Trainer 
• Knowledge of UB04 / CMS1500 claims, ICD-10 /Revenue/ CPT / HCPCS diagnosis and procedure coding, claim adjudication processes, EDI and OCR claim submission, 
• Medicare and Medicaid reimbursement methodologies including APR DRG / Exempt Units/ APG /RBRVS / APC. 

Required Skills

• Proven ability to analyze data and summarize in an organized and professional manner effectively and efficiently.
• Excellent verbal, written and presentation skills required.
• Ability to read and interpret contracts and other related documents required.
• Function in a fast-paced environment that requires prioritizing workloads and multi-tasking to complete projects on time.
• Team player that can work well independently and make decisions without excessive supervisory oversight.

EEO STATEMENT 

In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company’s equipment and facilities. For these reasons, ILS is committed to the eliminating of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.