About Us

Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.

Position Summary

This position is responsible for taking a leading role in Provider Data Mgmt., coordinating and ensuring completion of all client contracts, projects and change requests, reimbursement and the autoload processes. 

Essential Functions

1. Responsible for data integrity of all provider set-ups/amendments and provider contracts loaded to the claims system.
2. Oversight of internal QA Process
3. Program reimbursement setups applicable to the contract specifications. This includes fee for service pricing, capitation, pricing methods appropriate for inpatient, outpatient, ambulatory surgery, and emergency room settings.
4. Compile and prepare statistical data and reports.
5. Create and document workflows and policies and procedures (P&Ps) as necessary.
6. Participate in client implementation and conversion projects.
7. Represent the department by actively participating in internal meetings, external (client) meetings, and work sessions.
8. Assist in creating and maintaining all pricing setups in the claims system and ensure all updates are processed timely and accurately.
9. Educate and support staff in the interpretation and implementation of complex contract configurations into the claims system. Training (Initial and refresher)
10. Troubleshoot provider set-ups as necessary, in support of the claim processing operation.
11. Conduct other duties as requested by department management to ensure efficient company operations.
12. Client contact required.
13. Knowledge of fee schedule implementation.
14. Computer proficiency in Excel required.
15. Root cause analysis
16. Medicare and Medicaid reimbursement policy knowledge
17. Excellent verbal and written communication skills required.
18. Must be willing to represent ILS on Client calls/onsite meetings.
19. Experience in processing UB-04 / CMS 1500 claims required.
20. Proficiency and understanding of provider contracts.
21. Knowledge of the company’s proprietary claim systems necessary. Must possess good understanding of claim adjudication process.
22. Auditing experience preferred.

Education and Experience

• Associate degree or equivalent experience.
• Five (5) Years’ experience

Required Skills

• Excellent verbal and written communication skills required.
• Experience in processing UB-04 / CMS 1500 claims required.
• Computer proficiency in Excel required.

EEO Statement

In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company’s equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.