Configuration Specialist

Evolent Health, Inc. Lisle , IL 60532

Posted 2 weeks ago

It's Time For A Change

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely70.3% in year-over-year revenue growth in 2017. Are we recognized? Definitely. We have been named one of "Becker's 150 Great Places to Work in Healthcare" in 2016 and 2017, and one of the "50 Great Places to Work" in 2017 by Washingtonian, and our CEO was number one on Glassdoor's 2015 Highest-Rated CEOs for Small and Medium Companies. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it.

We are looking for bright and energetic individuals to join the Configuration Team in Health Plan Services. If you have a penchant for detail, are recent college graduates or have prior health insurance claims processing experience - is a plus but not required, we would like to talk with you! We will train the right candidates for this position.

Position Description:

  • Perform a variety of tasks related to the on-going maintenance and set up of client configurations with the core administrative system

  • Support client implementations, system upgrades and projects to improve performance

  • Participate in problem solving of provider, client, reporting or system issues

  • Potential to rotate through configuration support functions across key system areas and lines of business with the ability to develop subject matter expertise

Responsibilities:

  • Support activities to maintain data within the core claims processing system within the areas of Provider, Pricing or Rules. Potential responsibilities include and may vary by system area of assignment:

  • Managing of credentialing variables and demographics (credentialed and non-credentialed providers), contract or fee schedule assignment and network affiliation based on weekly Excel files submitted from the clients to Valence

  • Dictionary/master file maintenance such as research, set up and maintenance of all Diagnosis, CPT and other medical codes

  • Support maintenance of group/benefit additions, terms, changes

  • Support fee schedule maintenance including terms, affiliations and contract maintenance

  • Support the work to troubleshoot and resolve claims that suspend in work queues for configuration intervention in the claims processing system

  • Support audits of common entry or load errors to ensure accuracy

  • Support research efforts such as: NPI numbers and gather similar licensure data on providers entered into the claims processing system to ensure each provider is appropriately loaded

  • Participating in problem solving of the monthly files such as 837 Encounter File submissions and error corrections

  • Other duties related to system and report data integrity

The Experience You'll Need (Required):

  • Ability to work effectively on team that includes all levels of organization and Health Plan

  • Analytical Skills necessary to independently discover and outline systems related issues. Prior experience with Facets/RIMS, CSC or DST or a rules-based system a plus.

  • Intermediate skill level of Microsoft Excel a plus

  • Ability to support projects and recommend/implement process for project completion

  • Understanding of logic of standard medical coding manuals (i.e. CPT, ICD-9, HCPCS, etc).

  • Knowledge of claims adjudication and editing

  • Managed Care experience a plus

  • Detail oriented

  • Maintain confidentiality of company business

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.


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Configuration Specialist

Evolent Health, Inc.