As a Plan & Benefits Configuration Specialist III, you will focus on understanding, translating, and configuring medical and dental plan designs into the core claims platform to ensure accurate processing of claims. You will maximize effectiveness of the core claims platform by continuously evaluating current processes and business needs along with system capabilities. You will create logic sets, based on code mapping, with an emphasis on accuracy and proficiency.
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The Manager of Coding, Billing, and Documentation Integrity drives accurate coding, compliant billing, and strong clinical documentation practices across Theoria's primary care operations, focusing on professional fee services like E/M coding, chronic condition documentation, risk adjustment (HCC/RAF) capture, and denial prevention.