Configuration Analyst

We are seeking a Care Manager to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Configuration Analyst in the Health Care Services industry plays a critical role in ensuring that healthcare software systems and applications are accurately configured to meet organizational needs and regulatory requirements. This position involves analyzing system configurations, identifying areas for improvement, and implementing changes that enhance operational efficiency and data integrity. The analyst collaborates closely with clinical, administrative, and IT teams to tailor configurations that support member care workflows and compliance standards. By maintaining detailed documentation and performing rigorous testing, the Configuration Analyst ensures that system updates and new implementations function seamlessly within the healthcare environment. Ultimately, this role contributes to the delivery of high-quality healthcare services by optimizing the technological infrastructure that supports clinical and administrative processes.

Minimum Qualifications:

• High School diploma or GED required
• Minimum two (2) years' experience as a medical Senior Claim Examiner, Call Center Advocate, Business Analyst or Trainer
• Medicare and Medicaid reimbursement methodologies including APR DRG / Exempt Units/ APG /RBRVS / APC.

Preferred Qualifications:

• Associate's degree in health care or related fields
• Knowledge of UB04 / CMS1500 claims, ICD-10 /Revenue/ CPT / HCPCS diagnosis and procedure coding, claim adjudication processes, EDI and OCR claim submission
• Certification in Health IT or related fields (e.g., Certified Professional in Healthcare Information and Management Systems - CPHIMS).
• Knowledge of data analytics and reporting tools used in healthcare settings.
• Familiarity with project management methodologies and tools.
• Experience in training and supporting end-users in healthcare technology environments.

Responsibilities:

• Claims testing and processing including claim adjustments, as well as providing support and education to the staff as necessary.
• The incumbent will troubleshoot and resolve provider records to support the claims operation.
• Process claims in accordance with corporate policies and procedures and state regulations.
• Review and analyze a variety of claim samples including auto-adjudicated claims to assure pricing per contractual agreement, negotiated rate or to Medicaid and Medicare rates.
• Provide consistent feedback to Management in timely manner both individually and collectively.