Configuration Specialist - Pricing

Centivo Inc.

Job Overview

Location

Indiana, USA

Job Type

Full-time

Full Job Description

📋 Description

• Centivo is on a mission to revolutionize healthcare affordability and quality for the backbone of our economy – workers and their employers. We are seeking a meticulous and detail-oriented Configuration Specialist - Pricing to join our dynamic team. In this critical role, you will be instrumental in ensuring the accurate and timely configuration and maintenance of provider contract and pricing setups within Centivo’s core systems. Your expertise will directly impact our ability to provide timely and accurate claims adjudication and provider payments, upholding our commitment to making healthcare accessible and affordable.
• As a Configuration Specialist - Pricing, you will dive deep into the intricacies of provider contracts, translating complex legal and financial terms into functional configurations within our health plan database systems. This involves a thorough understanding of various reimbursement methodologies, fee schedules, and contractual obligations across physician, facility, and ancillary providers. Your ability to interpret and apply these terms accurately will be paramount to the success of our operations and the satisfaction of our network partners.
• A significant aspect of this role involves the hands-on configuration of pricing mechanisms and fee schedules. You will be responsible for setting up these configurations in Centivo’s proprietary pricing platform, ensuring they align perfectly with product design, functionality, and client-specific requirements. This includes conducting rigorous test validations to confirm accuracy and compliance before deployment, minimizing errors and ensuring a seamless claims administration process.
• Collaboration is key to this position. You will work closely with the Network Contracting and Provider Relations teams to ensure that newly established or updated contracts are correctly reflected across all relevant systems. This cross-functional partnership is vital for maintaining data integrity and operational efficiency, ensuring that all stakeholders have access to the most up-to-date and accurate provider information.
• You will also play a crucial role in coordinating with various business units and external vendors, particularly during client implementations. This involves ensuring that system interfaces are robust and meet both client expectations and Centivo’s operational standards. Your ability to communicate technical requirements and facilitate integration will be essential for successful project rollouts.
• A core responsibility is to identify contracts that may present challenges or incompatibilities with Centivo’s internal pricing platform. For these instances, you will collaborate closely with external pricing vendors, managing the integration of these complex contracts into their systems to ensure comprehensive coverage and accurate pricing. This requires a proactive approach to problem-solving and a strong understanding of platform limitations and capabilities.
• When questions arise regarding contract accuracy or pricing discrepancies, you will be the go-to expert. This involves performing in-depth analysis of claim impact reports to meticulously determine if claims have been priced correctly according to contractual terms. Your analytical skills will be critical in identifying root causes of pricing issues and recommending appropriate solutions.
• Based on your analysis, you will complete claim adjustments to rectify any pricing errors. This may stem from provider disputes, requests from internal departments, or findings from claim impact report analyses. You will also be responsible for implementing configuration changes identified through these processes, running and evaluating claim adjustment reports to confirm that corrections have been applied accurately within Centivo’s claim platform and supporting systems.
• Furthermore, you will contribute to the continuous improvement of our systems and processes by participating in unit and end-user testing. This includes testing new configurations, programming enhancements, new provider contracts, and software changes that impact claims adjudication rules. Your feedback and testing results will be invaluable in refining our technology and ensuring its optimal performance.
• As a valued member of the team, you will also have the opportunity to participate in special projects, acting as a liaison between user areas and technical teams to define business requirements and processes for project deployment. Additionally, you will provide technical support and training to other team members, fostering a collaborative and knowledgeable environment. Your dedication to accuracy, your analytical prowess, and your collaborative spirit will be essential in driving Centivo’s mission forward and making a tangible difference in the lives of millions.

🎯 Requirements

• Proven ability to read, interpret, and accurately configure provider contracts (physician, facility, ancillary) within health plan database systems, applying complex reimbursement methodologies and fee schedules.
• Demonstrated experience in analyzing claims for pricing accuracy against contract requirements, including the ability to perform claim adjustments and evaluate claim impact reports.
• Strong analytical and problem-solving skills with a keen attention to detail, capable of identifying platform limitations and collaborating with external vendors when necessary.
• Excellent verbal and written communication skills, with the ability to clearly convey complex technical information and understand intricate details from others.
• Minimum of 3 years of experience in provider contract configuration, health plan claims processing, or a closely related role.

🏖️ Benefits

• Competitive salary and comprehensive health benefits package.
• Opportunity to work remotely, offering flexibility and work-life balance.
• Be part of an innovative company with a powerful mission to make healthcare affordable and high-quality.
• Generous paid time off and holiday schedule.
• Opportunities for professional development and career growth within a rapidly expanding organization.

Skills & Technologies

Remote

Degree Required

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Centivo Inc.

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About Centivo Inc.

Centivo is a health plan administrator that partners with self-insured employers to provide affordable healthcare benefits. It builds custom networks of high-value primary care providers and specialists, emphasizing coordinated care, transparent pricing, and payment innovations like prospective bundled payments. The platform offers members digital tools for provider search, cost estimates, and care navigation, while giving employers predictable costs and data analytics to improve population health outcomes.

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