Health Plan Configuration Analyst is responsible for configuring benefit tables and payment/fee schedules in the claims adjudication system. Interface with department managers regarding system changes.
Minimum of associates' degree, bachelor's preferred, or equivalent experience in healthcare claims adjudication logic, database maintenance and project management.
Must have knowledge of CPT, ICD-9/ICD-10, HCPCS, Revenue Codes and pricing methodologies.
Minimum of 2-3 years Health Care industry knowledge and operations (example: claims processing, enrollment, provider file maintenance) with ability to interpret and document business requirements.
Demonstrated ability to process health care claims and to understand claim life cycle.
Strong analytical skills and problem solving skills.
Understanding of core processing systems in relation to configuration set-up.
Demonstrated understanding of working with government agencies such as CMS, Medicaid, etc. along with interpreting agency and contract requirements.
Strong computer skills with proficiency in MS Word, Excel, Outlook, and Access.
SQL experience preferred.
Excellent communication skills both verbal and written.
Ability to participate in a team environment.
Self-starter who requires minimal supervision.
Internal Number: 43316
About Cook Children's Health Care System
Cook Children's Health Care System is a not-for-profit, nationally recognized pediatric health care organization comprised of eight entities – a Medical Center, Physician Network, Home Health company, Northeast Hospital, Pediatric Surgery Center, Health Plan, Health Services Inc., and Health Foundation.Cook Children's Medical Center Based in Fort Worth, Texas, the integrated system has more than 60 primary and specialty care offices throughout North Texas. Its service region includes Denton, Hood, Johnson, Parker, Tarrant and Wise counties, with an additional referral area encompassing nearly half the state.Cook Children's traces its roots back to 1918, but throughout its continual change and robust growth, it still embraces an inspiring promise – to improve the health of every child in its region through the prevention and treatment of illness, disease and injury. To live up to this promise, Cook Children's combines the art of caring with the use of leading technology and extraordinary collaboration to provide exceptional care for every child, every day.History – Cook Children's has a rich history of nearly a century of caring for children.Our Promise – Knowing that every child's ...life is sacred, it is the promise of Cook Children's to improve the health of every child in our region through the prevention and treatment of illness, disease and injury.Companies – Based in Fort Worth, Texas, Cook Children's is a not-for-profit organization that is comprised of eight nationally recognized companies.Community Health Outreach – Cook Children's Community Health Outreach works together with over 150 partner organizations to improve the safety and health of at-risk children through education, disease and injury prevention and support.Clinical Research – Cook Children's is home to a skilled team of research-minded physicians, nurses and health care professionals and administrators who drive our commitment to excellent clinical care and the search for medical advances.Public Relations – Cook Children's Public Relations works with national and local media outlets, produces Cook Children's publications, coordinates special events and helps develop key relationships within the community.Contractor & Vendor Information – Cook Children's contractors and vendors must ensure their employees are knowledgeable about working with our organization.Sponsorship guidelines – Cook Children's sponsors a select number of events that are strongly aligned with its promise to improve the health of every child in the region through the prevention and treatment of illness, disease and injury.