Configuration Specialist - Contract Build

Configuration Specialist Contract Build

The Configuration Specialist Contract Build role is responsible for the accurate and timely configuration and maintenance of provider contract and pricing configurations within Centivo's core systems. This role involves interpreting contract terms, setting up fee schedules, and ensuring compliance with regulatory and organizational standards to support timely and accurate claims adjudication and provider payments. Key responsibilities include collaborating with the Network Contracting and Provider Relations team, configuring pricing mechanisms and fee schedules, coordinating with business units and vendors during client implementations, and ensuring system interfaces meet client and operational needs.

Responsibilities Include :

• Ability to read and interpret new and existing physician, facility and ancillary contracts.
• Perform manual pricing based on accurate interpretation of contract language.
• Configure and maintain provider contracts in the health plan's database systems.
• Interpret and apply contract terms, fee schedules, and reimbursement methodologies.
• Skilled in interpreting and implementing both new and existing contract pricing configurations within the Centivo pricing platform, ensuring comprehensive client and claims administration aligned with product design and functionality, and conducting necessary test validations.
• Identify contracts that are incompatible with Centivo's pricing platform and collaborate with external pricing vendors to ensure accurate integration of these contracts into their systems as needed.
• Collaborate with the Network Management, Provider Relations and Claims team when contracts are built or corrected to ensure updates are made in all systems pertaining to contracted providers.
• When contract accuracy is in question, analyze claim impact reports to determine if claims are priced correctly.
• Complete claim adjustments based on provider disputes, requests from internal departments and as determined by analyzing Claim Impact reports.
• Complete configuration changes as identified, run, and evaluate claim adjustment reports within Centivo's claim platform and supporting systems.
• Perform unit and / or end user testing for new configuration, programming enhancements, new provider contracts, and software changes as necessary that affect claims adjudication rules.
• Participate in special projects as needed and function as a liaison with specified user areas to define business requirements and processes for project deployment.
• Provide technical support and training for other team members as needed.

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Centivo Values :

Who we are :

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies.

Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.