Provider Network Configuration Specialist

The specialist supports new provider enrollment, system updates, reporting, and pulling data as needed, working primarily within Medisys (an internal/homegrown system), Jira ticketing, and the eHealth Deck for provider access and eligibility. This is a behind-the-scenes role responsible for provider and claims configuration, including loading and maintaining provider payments, new fee schedules, rate changes, and benefit configurations to ensure accurate claims processing.

Our client, a leading Insurance/Healthcare Company is looking for Provider Network Configuration Specialist and This is for an initial duration of 06 MonthsContract – Miami, FL
 
Job Title: Provider Network Configuration Specialist
Job Id: 26-04413
Location: Miami, FL
Duration: 06 Months Contract
Position Type: Hourly Contract Position (W2 only)

• The role is hybrid, requiring onsite presence at least three days per week, with training requiring full-time onsite attendance for the first 2–3 weeks.
• The position requires flexibility, as there will be overtime.
• Candidate will need to reside in South Florida training will take place in office for 2 weeks 8:00am – 4:30pm, normal shift 8:30am-5pm Est.
• Opportunity to convert to an FTE.
• The Provider Network Configuration Specialist (iCare) is a true administrative configuration role and not a call center position.
• This is a behind-the-scenes role responsible for provider and claims configuration, including loading and maintaining provider payments, new fee schedules, rate changes, and benefit configurations to ensure accurate claims processing.
• The specialist supports new provider enrollment, system updates, reporting, and pulling data as needed, working primarily within Medisys (an internal/homegrown system), Jira ticketing, and the eHealth Deck for provider access and eligibility.
• The ideal candidate will have a strong claims background, including reviewing claims and denials, understanding claims setup, and knowing how to troubleshoot and correct configuration or data-entry logic issues that impact claims processing.
• Experience with benefit configuration and medical coding is highly desirable, and vision experience is a plus.

Job Description
General Summary 

• Under direct supervision, work within and across department teams to maintain the configuration of providers, locations, groups, plans and benefit limits in the managing system.
• Ensure accurate and timely completion of production tickets assigned to ensure client satisfaction and retrention. Support provider management activities associated with provider data maintenance, credentialing activities, directory management and intake requests.  

Essential Functions 

• Research, resolve, document and accurately respond to provider, practice, business parter or administor inquires and service requests.
• Communicate and coordinate with providers, practices and other departments to ensure accurate information is available to support business needs.
• Add and update Benefits Limits, Groups, Plans, new providers, and new locations in system.
• Upload fee schedules to applicable systems.
• Responsible for accurate set up of direct deposits.
• Configure and provide appropriate web portal access to clients.
• Timely and accurately generate and deliver reports as requested.
• Responsible for new business configuration setups following established processes/protocols.
• Ensure requested information is delivered within specified timeframe and completed accurately.
• Maintain high standards in all written or verbal communications with providers.

Job Specifications
Typically has the following skills or abilities: 

• Two years of experience in health insurance information and data management systems.
• Strong understanding of health plan terminology.
• Computer proficiency, including Microsoft Excel and other MS Office tools.
• Strong analytical and critical thinking skills.
• Ability to read and write at a level necessary to accomplish the above tasks.
• Demonstrated ability to identify problems and provide creative solutions.
• Strong attention to detail, organizational skills and problem solving skills.
• Highly motivated and reliable indiviual with a strong sense of urgency; ability to meet tight deadlines.
• Excellent written and verbal communication skills.
• Ability to work independently and in a team environment.

Working Conditions 

• The working environment is generally favorable, lighting and temperature are adequate, and there are no hazardous or unpleasant conditions caused by noise, dust, etc.
• The above information on this description had been designed to indicate the general nature and level of work performed by employees within this classification.  It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job range.

Qualified candidates please send your word format updated resume at the earliest to Pavan:

Pavan.p@sunrisesys.com

[732-395-4444].
 
Thank You.