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Provider Configuration Jobs in Florida (NOW HIRING)

Phoenix Defense

CONFIGURATION/DATA MANAGER I

Orlando, FL · On-site

$60K - $62K/yr

Provides configuration management support regarding site request deliverables. * Analyzes and maintains the contents (hard copy and/or electronic copy) of the configuration management library ...

Starfish

Configuration Manager

Eglin, FL

Our team provides superior research, development, and engineering services to the Federal ... Torch Technologies is seeking a Configuration Manager to provide resources with knowledge of ...

Astrion

Senior Configuration Manager

FL · On-site

Provide expertise and advice for improvement of configuration management processes * Communicate effectively through written, verbal, and presentation methods * Prepare and coordinate correspondence ...

EPS Corporation

SR Configuration Management

FL · On-site

Job Title SR Configuration Management Location Florida - FL 32408 US (Primary) Job Type Full-time ... Provide CM oversight for hardware, software, and documentation in alignment with Navy and DoD ...

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Provider Configuration information

What are the key skills and qualifications needed to thrive as a Provider Configuration Specialist, and why are they important?

To excel as a Provider Configuration Specialist, you need strong analytical abilities, attention to detail, and a background in healthcare administration or related fields. Familiarity with claims processing systems, provider databases, and industry-standard platforms like Facets or QNXT, as well as knowledge of HIPAA regulations, is typically required. Excellent problem-solving skills, communication, and the ability to collaborate across departments help you stand out in this role. These competencies are crucial to ensure accurate provider data management, regulatory compliance, and smooth healthcare operations.

What are some common challenges faced in a Provider Configuration role and how can they be addressed?

Provider Configuration professionals often encounter challenges such as managing large volumes of complex provider data, ensuring timely updates to prevent claim processing errors, and interpreting intricate health plan requirements. Staying organized and detail-oriented is essential to avoid inaccuracies. Collaborating closely with IT, claims, and provider relations teams can help clarify requirements and resolve discrepancies quickly. Leveraging robust data management tools and participating in regular training can also enhance efficiency and accuracy in this role.

What is the difference between Provider Configuration vs Network Administrator?

AspectProvider ConfigurationNetwork Administrator
CredentialsCertifications like CompTIA Server+, vendor-specific certificationsCompTIA Network+, Cisco CCNA, Microsoft certifications
Work EnvironmentData centers, cloud platforms, service providersOffice networks, enterprise IT environments
Industry UsageTelecommunications, cloud services, hosting providersCorporate IT, educational institutions, healthcare

Provider Configuration specialists focus on setting up and managing service provider systems, often requiring certifications related to cloud and server management. Network Administrators handle network infrastructure within organizations, requiring networking certifications. While both roles involve technical setup, Provider Configuration is more aligned with service provisioning, whereas Network Administrators maintain internal network operations.

What is a Provider Configuration specialist?

A Provider Configuration specialist is responsible for setting up and maintaining healthcare provider information within insurance or healthcare systems. They ensure that provider data such as credentials, contracts, and network participation is accurately entered and updated in databases. This role is crucial for accurate claims processing, payment, and compliance with regulatory requirements. Provider Configuration specialists often work closely with providers, payers, and IT teams to ensure seamless integration and data integrity.
What are popular job titles related to Provider Configuration jobs in Florida? For Provider Configuration jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Provider Configuration jobs in Florida look for? The top searched job categories for Provider Configuration jobs in Florida are:
Provider Configuration jobs near you
Healthcare Configuration and Data Integrity Manager

Healthcare Configuration and Data Integrity Manager

Provider Network Solutions LLC

Miami, FL • On-site

$60K - $70K/yr

Full-time

Medical

Posted 15 days ago

Job description

Job Type
Full-time
Description
Position Summary
The Configuration and Data Integrity Manager is responsible for implementing and interpreting the organization's overall claims, provider configuration, eligibility and provider database management, security, and operations. The Configuration Manager will work with internal departments and external organizations to assure secure data exchanges, integrity, reliability, and availability; plans, organizes and coordinates activities related to the analysis and implementation of network database systems; provides technical guidance and database compliance audits; and consults with business users regarding the use and management of data.
Duties and Responsibilities
• Responsible for benefit configuration covered services, copay, deductibles, coinsurance and max out of pocket in TPA system. Ensure mapping and testing behind the scenes and maintain Matrix of Benefit Packages
Responsible for provider records configuration and contract rate load create vendors, practice locations, medical group, networks, reimbursement rate. Collaborate with Provider Relations Department and Credentialing to ensure Responsible for work distribution and resource management of configuration specialist and data integrity specialist.
• Configuration support to provider contracts-question if specific agreement received can be entered as noted.
• Conduct unit testing to ensure design meets specifications as it relates to product upgrades or new releases.
• Responsible for accurately interpreting specific contracts as well as additional business requirements and converting these terms to configuration parameters.
• Quality control of all information uploaded in TPA system, i.e., Provider data, fee schedules, network assignment, team member's responsibilities.
• Collaborate with provider call center, clinical and claims department when asked to verify specific provider configuration or benefit configuration information.
• Provide system configuration support to organization based on changing business needs.
• Review and recommend changes to existing configuration processes.
• Analyze and resolve Claims Workflow regarding Benefit & Contract configuration issues in a in with 3 business days.
• Provide technical guidance to Data Integrity Specialist in their assigned job duties.
• Oversee Configure Medicare/Medicaid/Commercial interest rates in TPA system.
• Resolve Eligibility Issues with Health Plans.
• Validate reports ran by Data Integrity Specialist on a weekly, monthly, and quarterly basis.
• Load and Maintain Fee Schedule in TPA System
• Act as liaison between Corporate and the health plan regarding programming development needs related to reporting.
Requirements
Knowledge
• 3-5 years of Claims Processing experience required.
• 1-2 years' experience in healthcare data management.
• Broad knowledge of medical terminology, customer service, claims processing and/or customary and reasonable cost containment, and coordination of benefits and diagnosis coding.
Skills
• Advanced knowledge of Microsoft applications: Outlook, access database, excel, word and basic computer navigation.
Salary Description
$60,000.00 - $70,000.00 per year

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