EZ-CAP Configurations Specialist - Astiva Health, Inc

Job Title: EZ-CAP Configurations Specialist

Target Compensation Range: $80,000 - $95,000/year, depending on the relevant qualifications and experience.

About Us:

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.

SUMMARY: Under the general supervision by the Manager of Information Systems, the Configurations Specialist configures and maintains provider contracts, fee schedules and code sets in the EZ-CAP claims adjudication system. Additionally, this position provides technical and administrative support to operational areas to ensure that system configuration and data is precise and ready to support the operational and business needs of Astiva Health and its various business partners.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Performs configuration activities which may include provider contracts, fee schedules and DOFR.
• Builds Benefits and ensures configuration meets established Astivas Explanation of Coverage.
• Loads new/updated contracts amendments, Medicare fee schedule, locality, ICD10, procedure codes and revenue codes into EZ-CAP.
• Test and audit claims payment accuracy against contract information loaded into EZ-CAP.
• Consults with Manager of Information System to determine appropriate interpretation and configuration of contract terms.
• Maintains detailed knowledge and understanding of EZ-CAP rules relative to claims payments and authorizations.
• Develops, documents, and executes test plan for configuration testing and validate accuracy of data loaded.
• Responds to system configuration flaws/errors and unresolved issues and proposes solutions.
• Claims adjudication and troubleshooting.
• Regular and consistent attendance
• Other duties as assigned

EDUCATION and/or EXPERIENCE

• Bachelor's degree in Healthcare Administration, Information Technology, or a related field
• 2+ years EZ-CAP knowledge is required.
• 2+ years Health Plan Medicare Line of Business experience
• Medicare Reimbursement / Denial experience
• Strong organizational skills: ability to multitask and properly manage time.
• Working knowledge of health care standard code sets, benefits, DOFR, RBRVS, and fee schedules.
• Knowledge and understanding of CMS-1500 and UB-04 Medical Claim Forms

BENEFITS:

• 401(k)
• Dental Insurance
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off