Support all claims processing including system configuration of QNXT for:
Provider contracts including physicians, groups, hospitals, laboratories and any other entities that submit claims for capitated or fee-for-service payments
Fee schedules, loaded annually as per plan requirements and maintenance of discounts and pay rates based on contracts
Health plan member benefits and eligibility
These resources are also responsible for ensuring the QNXT system functionality as configured accurately reflects the operational workflows defined for the departments above and are in compliance with all government and health plan requirements.
Ensure the appropriate fee schedules and system codes are accurately loaded, verified and maintained in QNXT.
A primary function of these resources is to provide real-time, being the point of contact to end-user department operations. They are expected to provide excellent customer service and a high level of responsiveness to system questions, requests and ad hoc issues brought to them by system end users, departmental managers, IT colleagues and collaborators.
Current ticket volume for QNXT configuration analysts is approximately 100 calls per month.
Use the HEAT ticketing system