Job Description: Configuration Specialist – Contract Build

Salary: $60K - $70K Location Type: Remote Employment Type: Full-Time

Position Overview

Centivo exists to provide affordable, high-quality healthcare to millions of individuals and employers who form the backbone of our economy. The Configuration Specialist – Contract Build 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

• 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.
• Interpret and implement new and existing contract pricing configurations within the Centivo pricing platform, ensuring comprehensive client and claims administration aligned with product design and functionality.
• Conduct necessary test validations for configurations.
• Identify contracts incompatible with Centivo’s pricing platform and collaborate with external pricing vendors for accurate integration.
• Collaborate with Network Management, Provider Relations, and Claims teams to ensure updates are made in all systems pertaining to contracted providers when contracts are built or corrected.
• Analyze claim impact reports to determine pricing accuracy when contract accuracy is in question.
• Complete claim adjustments based on provider disputes, requests from internal departments, and analysis of Claim Impact reports.
• Complete configuration changes, run, and evaluate claim adjustment reports within Centivo’s claim platform and supporting systems.
• Perform unit and/or end-user testing for new configurations, programming enhancements, new provider contracts, and software changes affecting claims adjudication rules.
• Participate in special projects as needed, functioning 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.

Required Skills and Abilities

• Demonstrated ability to identify when platform limitations or capabilities require a contract to be sent to an external pricing vendor.
• Ability to perform contract reviews to determine accuracy in configuration and correct as needed.
• Ability to analyze claims for pricing accuracy against contract requirements.
• Exemplary customer service skills demonstrated by researching and resolving configuration-related issues in a timely and accurate manner.
• Excellent analytical and problem-solving skills.
• Ability to work independently and as part of a team.
• Ability to multi-task and apply critical thinking skills.
• Strong attention to detail and accuracy.
• Enjoy working in a fast-paced environment managing multiple issues under pressure of production schedules and deadlines.
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information understandably.
• Ability to understand and interpret complex information from others, including reimbursement policy standards.