Maintain and update the GE/Centricity/IDX Managed Care Application (MCA) module for US Family Health Plan's managed care line of business
Build fee schedules, provider and vendor dictionary entries, and plan benefits and exclusions
Assist with health plan utilization management reporting for the organization
Ensure optimal payment methodology for payments from US Family Health Plan to vendors and other providers
Responsible for all reports and data transfers to the Department of Defense and its contractors
Provide support for the quality management program
Requirements
Bachelor’s Degree in related field or Equivalent experience in Health Care Business Administration as required by URAC.
Minimum of four years’ experience in managed care operations or large group practice setting.
Microsoft SQL Server experience
Must have knowledge of and experience in coding with both CPT and ICD-9 and ICD-10.
Must possess an understanding of financial/administration/clinical business functions and the interfaces/relationships between applications in healthcare.
Preferred: Experience with Access and reporting from a warehouse type database.
Preferred: Experience with HEDIS reporting.
Preferred: Experience with GE/Centricity/IDX healthcare software application.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities
Retirement 401(k) Savings Plan with employer matching
Health care benefits (medical, dental, vision)
Life insurance
Disability insurance
Time off benefits (paid parental leave, vacations, holidays, health issues)
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