Support pricing configuration, tables and codes which translate Magellan Health business policies into high quality, timely and efficient pricing configuration to provide accurate claims payment, reimbursement, and administration of multiple products in a managed care environment.

• Research, analyze, track and resolve basic issues with claims, configuration, and pricing.

• Perform basic rates configuration.

• Load provider pricing configuration requirements in rates table to ensure claims pay correctly related to provider contracts, agreements, authorization, and referrals.

• Interpret provider contracts, fee schedules and rates to set up configuration correctly to ensure providers are paid according to the contracts.

• Collaborate with stakeholders to gather, assess, interpret, and document customer needs and requirements.

• Consistently meet established productivity, schedule adherence, and quality standards while maintaining expected attendance.

• Create and maintain Fee Schedule Requirements to support GBD Pricing Configuration Solutions (PCS).

• Research claims issues to determine pricing configuration gaps, update configuration as appropriate.

• Audit configuration against contract requirements to verify configuration following source documentation.

• Performs other duties and special projects as assigned

  Other Job Requirements

Responsibilities

Bachelor's degree and up to 2 years of benefit configuration experience or equivalent combination of experience and education.

2+ years of claims analysis experience in a healthcare environment required.

Claims processing and provider data maintenance knowledge required.

Understanding of and experience related to healthcare claims payment configuration process/systems and its relevance/impact on network operations required.

Strong analytical and project management skills.

Excellent verbal and written communication skills.

Ability to review and/or maintain large data sets.

Ability to interact professionally with peers, leaders, and cross-functional teams.

Ability to analyze and document business processes.

Strong MS Office skills (Excel, Access, Word, Pivot Tables, Analytics).

Ability to focus on technology and business issues, as well as communicate appropriately with both technology and business experts.

General Job Information

Title

Rates Configuration Analyst

Grade

21

Work Experience - Required

Benefit Plan Configuration, Claims, Healthcare

Work Experience - Preferred

Education - Required

A Combination of Education and Work Experience May Be Considered., Bachelor's

Education - Preferred

License and Certifications - Required

License and Certifications - Preferred

Salary Range

Salary Minimum:

$45,655

Salary Maximum:

$68,485

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.