Category : IT Software Development
Location/City : MA - Springfield
Direct and oversee the set up and configuration of Amisys for the organization.
This individual is responsible for identifying, developing, implementing and supporting all Departments that use Amisys and configuring Amisys to direct the way in which the system evaluates, processes and reports information. This includes but is not limited to Authorization, Benefit Management, Billing & Accounts Receivable, Capitation, Claims Processing, Liability Recovery, Medical Management, Membership Processing, Pricing Management, Provider, Reference & Controls and System Parameters. Manage the Provider Enrollment and AWD Functions.
Determine appropriate standards and configurations for Amisys and ensure each is appropriately maintained and supported. 10%
Manage the Provider Enrollment Function which is responsible for maintaining the Provider Database. 10%
Manage the AWD Function which is responsible for the supporting automated workflows , including the Claims Department. 5%
Develop, manage and design the configuration of Amisys to support all Departments as outlined below: 35%
* Reference and Controls. This includes Code sets, Procedure codes, diagnosis codes, DRGs, counters, super-tables, and Amisys configuration tables that are used in provider, membership, benefits, pricing, medical management, claims and finance.
* Benefits, which includes benefits, components, riders, benefit packages and key words.
* ASO Employer groups, which includes benefit design, main default tables, alt provider records, specialty capitation and medical management.
* Pricing, which includes provider pay classes, counters and fee schedules per various provider agreements.
* Medical Management, which includes authorization requirements for the various plan designs.
* Finance, which includes Employer Group Billing, Claims Payable, Capitation Payable and Accounts Payable.
* Correspondence Generator, which includes letters, ID Cards and batch letter generation jobs.
* Liability Recovery, which includes LR tables, AY tables and COB.
Collaborate with Sales, Product Development, Provider Contracting, Claims Accounting, Underwriting and Payment Integrity to ensure products or agreements can be supported. 10%
Manage IT Configuration budget and expense costs. 5%
Participate on various Committees/Teams including Medical Policy Committee, Payment Policy, Network Operations and Product Development. 25%
Minimum Requirements: .
Bachelor’s degree in computer science or related field with more than 7 years configuration management experience or an equivalent combination of education and experience.
Experience with Amisys system configuration preferred
Experience with health care insurance, health care provider or health care vendor organization is required
Experience with MS Windows and MS Office required
Specialized knowledge or skills in claims processing and system configuration
Demonstrated leadership skills and qualities
Ability to manage multiple complex projects and tasks
Office environment; sitting for extended periods of time; work at a personal computer for extended periods of time.
Supervisory Responsibilities: List all positions reporting to this position and indicate whether they are direct or in-direct reports.
Direct Reports - Indirect Reports -
Provider Enrollment Manager Senior Provider Enrollment Representatives
Senior Configuration Analyst Provider Enrollment Representatives