Contract Configuration Specialist – RCM

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🔥 43 minutes ago

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Dayforce

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

👥 HR Tech

☁️ SaaS

💰 $1G Post-IPO Debt - Dayforce on 2024-03

HR Tech • SaaS

Dayforce is a cloud-based human capital management (HCM) platform that delivers HR, payroll, workforce management, and talent management solutions for employers. It is designed as an integrated SaaS application to help organisations manage employee lifecycle processes, time and attendance, payroll processing, benefits administration, and workforce analytics from a single system. Dayforce is primarily sold to businesses as an enterprise HR/payroll solution.

📋 Description

• This position is responsible for the successful implementation and support of the applications to include entering and maintaining billings plans and funding, systems and processes to support the company’s billing department, troubleshooting all system application issues that arise from end users, and support medical/retail store operations. • Plan set up and configuration. • Manually calculate claim allowable if applicable. • Analyze multiple Client/Payer Contracts (Commercial, Managed Medicare/Medicaid, straight Governmental, and Workers' Compensation) • Analyze all payer policies as they pertain to billing and system set up. • Validate the accuracy of all payer contracts including language, and rates, and are loaded and priced accurately. • Cross reference claims against fee schedules, contracted rates, payer policies, etc. to validate the system and claims are being paid based on contractual obligations. • Requires a thorough understanding of the applications and related business processes assigned. • Fully understands the purpose of each solution as it relates to the business's strategic direction. • Requires an understanding of the features of each system, including their core responsibilities and how they utilize each solution for their specific job requirements. • Requires an understanding of insurance carriers to support internal workers to resolve issues during the day. • Support external resources through the various companies from plan designs, insurance inquiries, and billing support issues. • Day- to- day support of practice locations. • Application configuration, testing, and support

🎯 Requirements

• The ability to "train the trainers" and train individuals in unique circumstances. • Requires an understanding of 837's and 835's. • A high school diploma or GED • Experience interpreting contracts that include rates, amendments, terminology, and the insurance industry process and procedures. • Strong decision-making and problem-solving skills • Familiarity with the CPTs, HCPCs, ICD-10, and CMS 1500 claim form • Strong analytical and mathematical skills • Prior experience with healthcare accounts receivables • Understanding of managed care contracts • Proficient in Microsoft Excel, Word, PowerPoint, Outlook • Good to excellent spelling, grammar and written communication skills • Ability to analyze and resolve unpaid claims issues