Job Description
**This position requires three days per week in office (Tues/Wed/Thurs) at 100 Church Street, NYC**
+ Implement and maintain the configuration of reimbursement rates and pricing methodologies needed to support contract terms with providers including contracted and out of network providers
+ Ensure configurations accurately match fee schedules and negotiated rates match contracts so that claims are priced accurately
+ Implement configuration of benefits to meet the needs of Product, Clinical, Medical Cost Management, and Regulatory requirements
+ Ensure the quality of the configuration to meet outcomes aligned with the stakeholder requirements
+ Ensure intake of provider contract related requests including gathering of all contract terms, contract creation, provider demographics & documentation required to validate a provider's eligibility and credentials for the purpose of providing care to our members
+ Ensure proper set-up and maintenance of our Provider Datab...
+ Implement and maintain the configuration of reimbursement rates and pricing methodologies needed to support contract terms with providers including contracted and out of network providers
+ Ensure configurations accurately match fee schedules and negotiated rates match contracts so that claims are priced accurately
+ Implement configuration of benefits to meet the needs of Product, Clinical, Medical Cost Management, and Regulatory requirements
+ Ensure the quality of the configuration to meet outcomes aligned with the stakeholder requirements
+ Ensure intake of provider contract related requests including gathering of all contract terms, contract creation, provider demographics & documentation required to validate a provider's eligibility and credentials for the purpose of providing care to our members
+ Ensure proper set-up and maintenance of our Provider Datab...