We exist for American workers and their employers — who are the backbone of our economy.  That is where Centivo comes in — our mission is to bring affordable, high-quality healthcare to the millions of Americans who struggle to pay their healthcare bills.

Centivo is looking for a Configuration Specialist – Contract Build II to join our team!

You will be responsible to work with the Network and Provider Relations team to interpret contract pricing for the Centivo provider network and configuring the contract in Centivo’s pricing platform for claim pricing and adjudication. This includes configuring the pricing mechanism and/or fee schedule in Centivo’s pricing platform, working with Centivo’s Network Contracting and Provider Relations team to ensure the appropriate fees are applying to claims, working with pricing vendors and building fee schedules. You will coordinate with all business units and external vendors during client implementations and/or conversions to determine requirements. You will ensure that interfaces between internal systems and vendor interfaces meet client needs as well as operational processes.

What you’ll do:                       

• Interpret new and existing contract pricing configuration in the Centivo pricing platform to perform all client and claims administration based on product design, functionality and perform test validation as needed.
• Identify contracts that cannot be configured in Centivo’s pricing platform and work with external pricing vendors to perform the necessary steps in getting the contract built into their system accurately.
• Collaborate with the Network Management, Provider Relations and Claims team when contracts are built or corrected to ensure updates are made in all systems pertaining to contracted providers.
• When contract accuracy is in question, analyze claim impact reports to determine if claims priced correctly.
• Complete claim adjustments based on provider disputes, requests from internal departments and as determined by analyzing Claim Impact reports.                               
• Complete configuration changes as identified, run and evaluate claim adjustment reports within Centivo’s claim platform and supporting systems.
• Perform unit and/or end user testing for new configuration, programming enhancements, new provider contracts, and software changes as necessary that affect claims adjudication rules.
• Participate in special projects as needed and act as a liaison with specified user areas to define business requirements and processes for project deployment.            

You should have:

• 2-4 years of experience processing claims and/or interpreting and configuring contracts and fee rules for simple provider contracts based on defined pricing methodologies.
• Demonstrated ability to identify when platform limitations or capabilities require a contract to be sent to an external pricing vendor.
• Ability to perform contract reviews to determine accuracy in configuration and correct as needed.
• Ability to analyze claims for pricing accuracy against contract requirements.
• Knowledge of professional and institutional claims adjudication.
• Understands health insurance benefit administration in a Self-Funded environment.
• Coding knowledge and experience with CPT, HCPCS, ICD10, CDT, Revenue, DRG and other relevant medical and industry-standard codes.
• Exemplary customer service skills demonstrated by researching and resolving issues that are configuration related in a timely and accurate manner.
• Ability to work independently, problem-solve, and make decisions.
• Enjoy working in a fast-paced environment managing multiple issues with pressure of production schedules and deadlines.
• Work collaboratively and influence others to drive results across multiple functional teams.
• 2-4 plus years of experience in TPA and self-funding processes and system configuration
• Prior experience with a highly automated and integrated claim adjudication system, El Dorado-Javelina preferred but not required.
• High school diploma or GED; associate or bachelor’s degree preferred.
• Proficiency in Microsoft Office applications and other web-based software applications and willing to learn new proprietary computer systems.

Pay Transparency
The ranges we place in our job postings reflect what we anticipate to be the minimum to maximum of the base salary for this role. Additionally, our overall benefits package includes a few things you may consider towards a total compensation such as bonus, health benefits (some employer paid), PTO, and equity option grants.  

Salary Range

$64,000—$75,000 USD

Who we are:

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions of working Americans who struggle to pay their medical bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.

Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.