• Job Type: Full-Time
  • Function: Business Intelligence
  • Post Date: 12/29/2020
  • Website: ilshealthservices.com
  • Company Address: 5200, Blue Lagoon Drive Suite 500, Miami, FL, 33126

About Independent Living Systems

Independent Living Systems, LLC, offers 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.

Job Description

This position is responsible for ensuring the accuracy of provider data records within the claims system.  The incumbent will be responsible for interpreting and implementing provider contracts and assist in projects related to provider data management & reimbursement. 

Duties and Responsibilities:

  • Responsible for data integrity of all provider set-ups and provider contracts loaded to the claims system.
  • Implement provider contracts and/or contract amendments and conduct provider setup testing as necessary.
  • Program reimbursement setups applicable the contract specifications.  This includes fee for service pricing, capitation, pricing methods appropriate for office based, inpatient, outpatient, ambulatory, and emergency room settings.
  • Assist with ad hoc projects as necessary to meet client & departmental goals.
  • Participate in internal meetings, external (client) meetings, and work sessions.
  • Assist in creating and maintaining all pricing setups in the claims system and ensure all updates are processed timely and accurately.
  • Troubleshoot provider set-ups to support provider reporting, directory and claims operation.
  • Conduct other duties as requested by department management to assure efficient company operations.

  • Associated degree minimum or equivalent experience.
  • Minimum two (2) years industry experience required.
  • Experience in processing UB-04 / CMS 1500 claims required.
  • Familiarity provider contracts and reimbursement setup.
  • Knowledge of companies proprietary claim systems preferred.
  • Must possess good understanding of claim adjudication process.
  • Proficient knowledge of UB04 / CMS-1500 claim adjudication process, including Medicare and Medicaid reimbursement methodologies (i.e. Per Diem, Medicare PPS, FFS, APG, Capitation, etc.) required.
  • Excellent verbal and written communication skills required.
  • Computer proficiency in Microsoft applications (i.e. Excel and Access) required

    Physical Demands and Work Environment:
    The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
    While performing the duties of this position, the employee is regularly required to talk or hear.  The employee frequently is required to use hands or fingers, handle or feel objects, tools or controls.  The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl.
    The employee must occasionally lift and/or move up to 25 pounds, and infrequently up to 50 pounds.  Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision, and the ability to adjust focus.
    The noise level in the work environment is usually moderate.
    Equal Opportunity Employer

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Disclaimer: Local Candidates Only
This company does NOT accept candidates from outside recruiting firms. Agency contacts are not welcome.