Configuration Coordinator

Summary

Medica is a nonprofit health plan serving more than a million members and partnering with providers to deliver personalized health care experiences. The Configuration Coordinator manages and maintains business rules across core system applications, supports new market and product implementations, and resolves system inaccuracies affecting claims payment and related processes.

Responsibilities

• Responsible for all tasks related to configuration and maintenance of the business rules within core system ecosystem. Performs other duties as assigned
• Medica's Configuration Coordinator is responsible for all tasks related to configuration and maintenance of business rules within the ecosystem, including COSMOS, UNET, HealthRules, and others
• Medica's Configuration Coordinators play a key role in the configuration and implementation of new markets and products and manage the configuration of business rules that support reimbursement policies and methodologies, member/provider contracts, enrollment, billing, role-based security, and correspondence
• In addition, the Configuration Coordinator identifies, researches, and resolves inaccuracies and inconsistencies in the system as they impact claims payment and other upstream and downstream transactions and processes
• This opening will focus primarily on benefits and claims configuration within the HealthRules Payor application

Skills

• Bachelor's degree in Business Administration, Healthcare Administration, Healthcare Management, Healthcare Informatics, or a related degree program; or an equivalent combination of education and related work experience
• 1+ years of related experience, including configuration knowledge, system workflow, and/or design
• Proficiency in Microsoft Office Suite, including Excel and/or Access
• All candidates must be legally authorized to work in the United States at the time of application
• Experience implementing and configuring health plan core administration systems (e.g., FACETS, QNXT, Trizetto, MetaVance, HealthRules, IKASystems, Amisys, COSMOS, UNET) strongly preferred
• Healthcare experience strongly preferred
• Claims processing, claims adjudication, and coding knowledge (CPT, HCPC, ICD-10, Revenue, DRG, or other relevant medical and industry-standard codes) strongly preferred
• Demonstrated ability to meet deadlines
• Strong commitment to quality and service
• Strong verbal and written communication

Qualifications

Must Haves

• Bachelor's degree in Business Administration, Healthcare Administration, Healthcare Management, Healthcare Informatics, or a related degree program; or an equivalent combination of education and related work experience
• 1+ years of related experience, including configuration knowledge, system workflow, and/or design
• Proficiency in Microsoft Office Suite, including Excel and/or Access
• All candidates must be legally authorized to work in the United States at the time of application

Nice to Haves

• Experience implementing and configuring health plan core administration systems (e.g., FACETS, QNXT, Trizetto, MetaVance, HealthRules, IKASystems, Amisys, COSMOS, UNET) strongly preferred
• Healthcare experience strongly preferred
• Claims processing, claims adjudication, and coding knowledge (CPT, HCPC, ICD-10, Revenue, DRG, or other relevant medical and industry-standard codes) strongly preferred
• Demonstrated ability to meet deadlines
• Strong commitment to quality and service
• Strong verbal and written communication

Benefits

• Remote role; will work remotely 100% of the time.
• Competitive medical benefits
• Dental benefits
• Vision benefits
• PTO
• Holidays
• Paid volunteer time off
• 401K contributions
• Caregiver services