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Department: Ops - Contract Configuration

Location: 600 City Parkway West 10th Floor, Orange, CA 92868

Compensation: $130,000 - $150,000 / year

• Team Leadership & Oversight
  • Manage and mentor a team of Contract Configuration Specialists
  • Establish priorities, set performance goals, and oversee daily configuration workload.
  • Develop training plans and process documentation to ensure team effectiveness and compliance with business standards.
• Configuration Management
  • Oversee the setup, coding, and maintenance of provider contracts, fee schedules, and Division of Financial Responsibility (DOFR) agreements.
  • Ensure that all configurations comply with business rules, regulatory guidelines, and corporate policies.
  • Validate system configuration accuracy and conduct audits to confirm alignment with contract terms.
• Cross-Functional Collaboration
  • Partner with Provider Contracting, Claims, and IT to interpret contract language and translate it into system logic.
  • Work with Business Analysts to test new system releases, recommend enhancements, and manage configuration-related projects.
• Quality Assurance & Testing
  • Mainain and approve test plans for configuration changes, including new fee schedules and contract updates.
  • Lead root-cause analysis for configuration-related payment errors and drive process improvements.
• Data Management & Compliance
  • Ensure timely loading and maintenance of Provider and Facility contracts, ICD codes, CPT/HCPCS codes, and revenue codes.
  • Maintain up-to-date configuration documentation, including contract matrices, rate sheets, and audit logs.
  • Support internal and external audit activities by providing data and ensuring adherence to compliance standards.
• Continuous Improvement
  • Identify opportunities to streamline configuration workflows and automate manual processes.
  • Develop and monitor key performance indicators (KPIs) related to configuration accuracy, turnaround time, and claims payment integrity.
  • Champion system and process enhancements to improve data quality and reduce claims rework.
    
    

• Bachelor’s degree in Business, Healthcare Administration, Information Systems, or related field required. Master’s degree preferred.
• 5+ years of experience in healthcare claims systems, provider contracting, or configuration management.
• 2+ years in a supervisory or managerial capacity.
• Hands-on experience with EZ-CAP or similar claims administration platforms
• Strong understanding of provider reimbursement methodologies, managed care contracting, and benefit plan structures.
• Proficiency with Excel, and data validation tools a plus.
• Excellent communication, analytical thinking, and problem-solving abilities.
• Proven ability to manage competing priorities and lead cross-functional teams in a fast-paced environment.

• Experience working with Medicare Advantage, Medi-Cal/Medicaid, and Commercial plan configurations.
• Knowledge of healthcare regulatory requirements (CMS, DHCS, DMHC).
• Experience with system implementations or configuration migrations.
  
  

• The total compensation target pay range for this role is $125,000 - $150,000. The salary range represents our national target range for this role.
• Our organization follows a hybrid work structure where the expectation is to work both in-office and at home on a weekly basis. The office is located at 600 City Pkwy W Suite 1000, Orange, CA 92868.