Configuration Specialist (8875)

Terros Health is a healthcare organization of caring people, guided by our core values of integrity, compassion and empowerment, with diversity woven throughout. We engage people in whole person health through an integrated care delivery system, thus establishing a medical home for our patients.  In caring for the whole person, we focus on overall wellness through physical health, mental health and substance use care.  Our mission is to provide extraordinary care by empowered people through exceptional outcomes.

This position assists the Director, RCM and other Configuration Specialists in correctly configuring the company practice management system (NextGen) in context of medical policies, reimbursement policies, clinical editing policies, regulatory requirements and contract details to ensure appropriate billing, payment/encounter posting, and reporting of all claims processing activities. This position reports to the Director of Revenue Cycle Management.

HOPE  ~  HEALTH  ~  HEALING

Develop and maintain an understanding of current payer and NextGen configuration rules, contracts, and policies.

Assists in the accurate and timely loading of the following (including annual updates):

o    Payor contracts

o    Providers

o    Fee schedules

o    Code set mapping.

o    Specialized rules and alerts in Nextgen EPM

• Develop and maintain configuration documentation and communicate configuration processes, changes and best practices.
• Assists in the development and execution of test scenarios for configuration changes
• Assists in the maintenance of system flags and understands the impact of the system flags on the claims and EHR system.
• Develop and monitor post-production audit reports to ensure the intent of NexGen EPM configuration related change and/or project requirements are met
• Run and analyze ad-hoc reports
• Meets department production and quality standards.

• Assists in preparing and delivering reports and recommendations on claims payable accuracy and timeliness and related configuration opportunities to enhance revenue cycle department performance.

• Assist in the implementation of high-level quality and performance management initiatives.
• Accountable for outstanding customer service to all external and internal customers.
• Develops and maintains effective relationships through effective and timely communication.
• Take initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.

• Documentation of approved software changes, updates, patches and notification of software releases including the tracking of action items and capturing software changes.

• Maintain all applicable configuration baseline documentation

• Participates in code reviews, fixes any defects, and performance problems discovered in testing; and participates in transitions of the application components to the testers.

• Coordinates and assists the Director of Revenue Cycle Management in outside vendor audit compilation and tracking.
• Use sound judgment to determine when to escalate issues and to whom to ensure the highest quality resolution

Benefits & Wellness

We invest in the health, well-being, and success of our employees and their families by offering comprehensive benefits, wellness resources, and opportunities to grow both personally and professionally

• Multiple medical plan options, including a no-premium plan for employees and their families
• Multiple dental plan options, including orthodontic coverage
• Vision insurance
• Group life and disability insurance
• Pet insurance

• 401(k) plan with company match
• Interest-free medical line of credit
• Financial education, planning, and support resources
• Monetary company contribution toward eligible benefits
• Bilingual pay differential

• Generous Paid Time Off (PTO) – 3 weeks off in the first year
• Paid Sick Time
• 10 paid holidays annually

• Comprehensive wellness program featuring wellness challenges, activities, and prizes
• Employee Assistance Program (EAP) available to employees and their family members
• Trip Reduction Program

• Ongoing professional growth and career development opportunities, including:
  • Scholarships
  • Clinical supervision
  • Continuing Education Units (CEUs)
  • Tuition discounts through Grand Canyon University, University of Phoenix, and Northern Arizona University (NAU)

• Access to the Working Advantage® Employee Discount Program, with savings on:
  • Gym memberships
  • Car rentals
  • Flights, hotels, movie tickets, and more

• Equivalent to five (5) years’ work configuration experience or a combination of claims processing, healthcare system operations, data analytics and configuration experience
• Required: High School diploma or equivalent. Associate’s degree preferred.
• Working knowledge of managed care operations and claims billing systems required. Working knowledge of NextGen EHR/EPM platform required. NextGen certification is preferred.
• Experience with provider and fee schedule configuration with the ability to analyze and translate data into useful information.
• Understanding of industry standard code sets, government regulations as mandated by the regulatory agencies.
• Analytical and quantitative skills to identify company impacts downstream because of outdated or inaccurate configuration.
• Intermediate Microsoft Office experience with an emphasis on MS Excel to manipulate and communicate data.
• Highly organized with the ability to effectively manage multiple projects simultaneously
• Ability to work well independently.
• This role is a non-driving position. May be 18 years of age and with less than two years’ driving experience or no driving experience.
• Must have a valid Level 1 Arizona Fingerprint Clearance card or apply for one within 7 working days of assuming role.
• Must pass background check, TB test and other pre-employment screening

Physical demands of this position are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.