Contract Configuration Specialist

Prospect Medical
Quality Service – Quality CareProspect Medical is California’s 10th largest IPA---and growing! Come join our team of dedicated professionals committed to providing quality service and quality care to our 9000+ primary care and specialist physicians and to our 178,000+ members.Prospect Medical, centrally located in Santa Ana is seeking a Full-time Fee Schedule Analyst for our Contracting Department.
FEE SCHEDULE ANALYST RESPONSIBILITIES:
•Ensure the privacy and confidentiality of all patient information and strictly adhere to all company policies.
•Load and maintain standard fee schedules that are updated quarterly and annually such as the Medicare and Medi-Cal fee schedules.
•Load and maintain custom fee schedules based on contract terms.
•Assign the appropriate fee schedules to providers including writing and determining hierarchy of exceptions to the primary fee schedule based on the terms of the provider’s contract.
•Build capitation schedules and assign capitation rates for capitated Primary Care and Specialist providers.
•Creates correspondence and fee schedule files for AB1455 notifications.
•Assist in meeting compliance issues for state and federal guidelines.
•Other duties as assigned.REQUIREMENTS:
•High school diploma or equivalent.•Previous programming experience highly preferred.
•Previous Health Plan interaction with a minimum of one year IPA/Medical Group experience.If you are a qualified, high-achieving professional who wants to make a positive difference in the world of managed care,please submit your resume with the job title in the subject line to:EMAIL: [Click here for email]FAX: 714-560-7330Prospect Medical has a solid past and a dynamic future. Nearly 20 years old, we have grown and matured---we are now publicly-traded (AMEX:PZZ), IPA and medical management services company. We contract with all major regional HMO’s including PacifiCare, Blue Cross, Health Net and CIGNA. We are now serving California’s seniors with a superior Medicare program, and we are pursuing additional growth through a strategy of targeted acquisition. We succeed through the use of superior technology, proven management procedures, and committed employees. Our success allows us to offer an excellent salary and one of the best benefit packages in the industry.
Please visit our website for more information and a listing of all our open positions
www.prospectmedicalholdings.com
REQUIREMENTS
REQUIREMENTS:
•High school diploma or equivalent.•1 year programming experience preferred.
•Previous Health Plan interaction with a minimum of one year IPA/Medical Group experience.