Sr Configuration Specialist - Provider
Apply NowCompany: Summa Health
Location: Akron, OH 44312
Description:
Sr Configuration Specialist - Provider
SummaCare - 1200 E Market St, Akron, OH
Full-Time / 40 Hours / Days
Hybrid after training
SummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a regional, provider-owned health plan, SummaCare is based in Akron, Ohio, and provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.
Summary:
Performs complex/multi-faceted provider demographic and network configuration, testing and implementation in claims system and surrounding systems as needed to efficiently and accurately adjudicate claims and support reporting processes. Acts as liason between Configuration and other departments. Contributor in implementation of new health plan business (new product lines or new client accounts), changes to existing health plan business (service area changes, network development, product line changes), issue resolution, and other large projects related to configuration of provider networks. Mentors new Configuration staff.
Formal Education Required:
-Bachelor Degree in a business or healthcare-related field or equivalent combination of education and/or experience.
Experience & Training Required:
-Four (4) years experience to include system configuration/testing, claims processing, provider credentialing, provider contracting or and/or working knowledge of claims/provider data elements that support healthcare operations. Experience in configuration systems testing or quality assurance would also be applicable. Amisys system experience preferred.
Other Skills, Competencies and Qualifications:
-Microsoft Office; Word and Excel at an advanced level and Access at an intermediate level
-Microsoft SQL Server Management Studio strongly desired
-Experience with building, maintaining or report building using relational databases.
-Ability to communicate in a professional manner to a wide variety of audiences, including Senior Leadership. This includes presentations, correspondence, instructional material, reports, policies and procedures, legal and or technical documents. Excellent proofreading skills.
-Strong analytical skills to review data from a variety of sources in order to make recommendations/conclusions based on the outcomes.
-Excellent attention to detail and strong trouble shooting skills.
-Organize and manage time to accurately complete tasks within defined timeframes in a fast-paced, often changing environment.
-Maintain current knowledge of and comply with regulatory and business information.
-Maintain confidentiality of member health and business information.
-Independent judgement, decision making, problem solving.
Level of Physical Demands:
-Light: Exerts up to 20 pounds of force occasionally and/or up to ten pounds of force frequently, and/or a negligible amount of force continuously.
Equal Opportunity Employer/Veterans/Disabled
$36.47/hr - $43.76/hr
The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.
SummaCare - 1200 E Market St, Akron, OH
Full-Time / 40 Hours / Days
Hybrid after training
SummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a regional, provider-owned health plan, SummaCare is based in Akron, Ohio, and provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.
Summary:
Performs complex/multi-faceted provider demographic and network configuration, testing and implementation in claims system and surrounding systems as needed to efficiently and accurately adjudicate claims and support reporting processes. Acts as liason between Configuration and other departments. Contributor in implementation of new health plan business (new product lines or new client accounts), changes to existing health plan business (service area changes, network development, product line changes), issue resolution, and other large projects related to configuration of provider networks. Mentors new Configuration staff.
Formal Education Required:
-Bachelor Degree in a business or healthcare-related field or equivalent combination of education and/or experience.
Experience & Training Required:
-Four (4) years experience to include system configuration/testing, claims processing, provider credentialing, provider contracting or and/or working knowledge of claims/provider data elements that support healthcare operations. Experience in configuration systems testing or quality assurance would also be applicable. Amisys system experience preferred.
Other Skills, Competencies and Qualifications:
-Microsoft Office; Word and Excel at an advanced level and Access at an intermediate level
-Microsoft SQL Server Management Studio strongly desired
-Experience with building, maintaining or report building using relational databases.
-Ability to communicate in a professional manner to a wide variety of audiences, including Senior Leadership. This includes presentations, correspondence, instructional material, reports, policies and procedures, legal and or technical documents. Excellent proofreading skills.
-Strong analytical skills to review data from a variety of sources in order to make recommendations/conclusions based on the outcomes.
-Excellent attention to detail and strong trouble shooting skills.
-Organize and manage time to accurately complete tasks within defined timeframes in a fast-paced, often changing environment.
-Maintain current knowledge of and comply with regulatory and business information.
-Maintain confidentiality of member health and business information.
-Independent judgement, decision making, problem solving.
Level of Physical Demands:
-Light: Exerts up to 20 pounds of force occasionally and/or up to ten pounds of force frequently, and/or a negligible amount of force continuously.
Equal Opportunity Employer/Veterans/Disabled
$36.47/hr - $43.76/hr
The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.