We are seeking a System Configuration Coordinator to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Coordinator, System Configuration plays a critical role in ensuring the accuracy, completeness, and appropriateness of claim determinations and payments. This position is responsible for testing and reviewing claims including adjustments to support accurate system configuration and efficient claims processing. The coordinator works closely with internal teams to validate system updates, analyze processing issues, and identify opportunities for improvement. Additionally, this role supports staff through training and guidance, helping to ensure consistent application of policies and procedures across the organization.
Minimum Qualifications:
- High School diploma / GED required
- At least 2 years of experience in system configuration or administration within a healthcare environment.
- Knowledge of UB04 / CMS1500 claims, ICD-10 / Revenue / CPT / HCPCS diagnosis and procedure coding, claim adjudication processes, EDI and OCR claim submission.
- Proven ability to effectively and efficiently analyze data and summarize in an organized and professional manner.
- Relevant experience may substitute for the educational requirement on a year-for-year basis.
Preferred Qualifications:
- Associate’s degree in Health Information Management, Information Technology, Computer Science, or a related field.
- Certified Professional in Healthcare Information and Management Systems - CPHIMS).
- Knowledge of database management
Responsibilities:
- Support testing of claim adjudication system programming, including benefit thresholds, authorization rules, and timely filing parameters.
- Assist with testing and validation of system modifications before migration to production.
- Review and analyze claims and adjustments to ensure correct pricing and identify root causes of processing errors.
- Identify trends and recommend policy or procedure changes to improve accuracy and performance.
- Provide guidance and support to staff on coding, edits, and policy application, and maintain quality data.
Skills Required
- High School diploma or GED
- At least 2 years experience in system configuration or administration within a healthcare environment
- Knowledge of UB04 and CMS1500 claims
- Familiarity with ICD-10, Revenue, CPT, and HCPCS coding
- Understanding of claim adjudication processes, EDI and OCR claim submission
- Proven ability to analyze data and summarize findings professionally
- Relevant experience may substitute for educational requirement on a year-for-year basis
- Associate's degree in Health Information Management, IT, Computer Science, or related field
- Certified Professional in Healthcare Information and Management Systems (CPHIMS)
- Knowledge of database management
What We Do
Independent Living Systems, LLC, offers a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid and Dual-Eligible Market. Independent Living Systems has been an industry leader in managing home and community-based programs for over 16 years. Leveraging ILS’ award winning technology platform, ILS provides assistance beyond the clinical realm at every stage of care from hospitalization to the treatment of chronic illnesses to personalized care management including nutritional support. As one of the country’s leading providers of Nutritional Support Services and medically tailored meals, ILS provides nutrition counseling and home delivered meals for individuals transitioning from acute settings to the home as well as for those combatting the effects of one or more chronic diseases. In partnership with health plans, providers, hospitals, and pharmaceutical and medical device companies, ILS provides solutions aimed at improving health outcomes while rebalancing costs. ILS’ suite of products and services include: MLTSS - Managed Long-Term Services Supports Suite of solutions including assessments, care management, and coordination of home and community-based services, care planning, and back-office support CCM - Comprehensive Care Management A streamlined solution for ongoing care management and care optimization targeted towards special needs populations and special needs plans Meals and Nutrition One of the nation’s largest nutritional providers delivering consistent, high-quality therapeutic meals to elderly and at-risk populations TPA – Third Party Administration A fully integrated business and technology offering to support all administrative and financial reporting requirements of health plans and risk bearing entities MSO – Management Services Organization Population and provider-based interventions to address utilization and monitor unit costs of services For more information please contact us via email at [email protected].
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