Randstad UAT-Contract Configuration in Trenton, New Jersey
Wednesday, October 5, 2016
MUST HAVE Strong:
Contracts (Provider Contracts/Professional Contracts/Facility Contracts/Ancillary Contracts)
Claims Processing Experience
Medicare Benefits Experience
Configuration and QA for provider contracts
Verify TRIZETTO rates sheet in pricer and compare with contracts rates and identify issues.
Actively participate and interact with TRIZETTO solution team to define and refine mapping and configuration issues.
Responsible for all aspects of provider, facility, and ancillary rate configurations within set deadlines, while ensuring full accuracy of contract loads.
Collaborates with Network Management and Analytics to ensure proper capture of negotiated and modeled contractual agreements.
Responsible for the identification and correction of rate load problems.
Serves as a subject matter expert with all contract configuration, fee schedule / grouper, and rate reimbursement matters.
Analyzes negotiated contracts to determine interaction with the core systems ensuring that reimbursement is in line with negotiated intent.
Validate system modification such as CPT Crosswalk, Procedure file, Rates configuration other updates and perform User Acceptance Testing (UAT).