Claims Configuration Jobs in Arizona (NOW HIRING)

Terros Health is a healthcare organization of caring people, guided by our core values of integrity, compassion and empowerment, with diversity woven throughout. We engage people in whole person health through an integrated care delivery system, thus establishing a medical home for our patients.  In caring for the whole person, we focus on overall wellness through physical health, mental health and substance use care.  Our mission is to provide extraordinary care by empowered people through exceptional outcomes.

This position assists the Director, RCM and other Configuration Specialists in correctly configuring the company practice management system (NextGen) in context of medical policies, reimbursement policies, clinical editing policies, regulatory requirements and contract details to ensure appropriate billing, payment/encounter posting, and reporting of all claims processing activities. This position report to the Director of Revenue Cycle Management.

HOPE  ~  HEALTH  ~  HEALING

Terros Health made the list!!

"Most Admired Companies of 2020, 2022 & 2023" as awarded by AZ Big Media.

Develop and maintain an understanding of current payer and NextGen configuration rules, contracts, and policies.

Assists in the accurate and timely loading of the following (including annual updates):

o    Payor contracts

o    Providers

o    Fee schedules

o    Code set mapping.

o    Specialized rules and alerts in Nextgen EPM

• Develop and maintain configuration documentation and communicate configuration processes, changes and best practices.
• Assists in the development and execution of test scenarios for configuration changes
• Assists in the maintenance of system flags and understands the impact of the system flags on the claims and EHR system.
• Develop and monitor post-production audit reports to ensure the intent of NexGen EPM configuration related change and/or project requirements are met
• Run and analyze ad-hoc reports
• Meets department production and quality standards.

• Assists in preparing and delivering reports and recommendations on claims payable accuracy and timeliness and related configuration opportunities to enhance revenue cycle department performance.

• Assist in the implementation of high-level quality and performance management initiatives.
• Accountable for outstanding customer service to all external and internal customers.
• Develops and maintains effective relationships through effective and timely communication.
• Take initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.

• Documentation of approved software changes, updates, patches and notification of software releases including the tracking of action items and capturing software changes.

• Maintain all applicable configuration baseline documentation

• Participates in code reviews, fixes any defects, and performance problems discovered in testing; and participates in transitions of the application components to the testers.

• Coordinates and assists the Director of Revenue Cycle Management in outside vendor audit compilation and tracking.
• Use sound judgment to determine when to escalate issues and to whom to ensure the highest quality resolution

Benefits & Wellness

• Multiple medical plans - including a no premium plan for employees and their families
• Multiple dental plans - including orthodontia
• Financial well-being - 401(k) with a company match, interest free medical line of credit, financial education, planning, and support
• 4 Weeks of paid time off in the first year
• Wellness program
• Pet Insurance
• Group life and disability insurance
• Employee Assistance Program for the Whole Family
• Personal and family mental and physical health access
• Professional growth & development - including scholarships, clinical supervision, and CEUs
• Tuition discounts with GCU and The University of Phoenix
• Working Advantage - Employee perks and discounts
  • Gym memberships
  • Car rentals
  • Flights, hotels, movies and more
• Bilingual pay differential

• Equivalent to five (5) years’ work configuration experience or a combination of claims processing, healthcare system operations, data analytics and configuration experience
• Required: High School diploma or equivalent. Associate’s degree preferred.
• Working knowledge of managed care operations and claims billing systems required. Working knowledge of NextGen EHR/EPM platform required. NextGen certification is preferred.
• Experience with provider and fee schedule configuration with the ability to analyze and translate data into useful information.
• Understanding of industry standard code sets, government regulations as mandated by the regulatory agencies.
• Analytical and quantitative skills to identify company impacts downstream because of outdated or inaccurate configuration.
• Intermediate Microsoft Office experience with an emphasis on MS Excel to manipulate and communicate data.
• Highly organized with the ability to effectively manage multiple projects simultaneously
• Ability to work well independently.
• This role is a non-driving position. May be 18 years of age and with less than two years’ driving experience or no driving experience.
• Must have a valid Level 1 Arizona Fingerprint Clearance card or apply for one within 7 working days of assuming role.
• Must pass background check, TB test and other pre-employment screening

Physical demands of this position are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.