System Configuration Coordinator

We are seeking a System Configuration Coordinator to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Coordinator, System Configuration plays a critical role in ensuring the accuracy, completeness, and appropriateness of claim determinations and payments. This position is responsible for testing and reviewing claims including adjustments to support accurate system configuration and efficient claims processing. The coordinator works closely with internal teams to validate system updates, analyze processing issues, and identify opportunities for improvement. Additionally, this role supports staff through training and guidance, helping to ensure consistent application of policies and procedures across the organization. 

Minimum Qualifications:

• High School diploma / GED required
• At least 2 years of experience in medical claims processing, medical billing, or as a call center advocate within a healthcare environment.
• Knowledge of UB04 / CMS1500 claims, ICD-10 / Revenue / CPT / HCPCS diagnosis and procedure coding, claim adjudication processes, EDI and OCR claim submission.
• Proven ability to effectively and efficiently analyze data and summarize in an organized and professional manner. 
• Relevant experience may substitute for the educational requirement on a year-for-year basis.

Preferred Qualifications:

• Associate’s degree in Health Information Management, Information Technology, Computer Science, or a related field.
• Certified Professional in Healthcare Information and Management Systems - CPHIMS).
• Knowledge of database management

Responsibilities:

• Support testing of claim adjudication system programming, including benefit thresholds, authorization rules, and timely filing parameters.
• Assist with testing and validation of system modifications before migration to production.
• Review and analyze claims and adjustments to ensure correct pricing and identify root causes of processing errors.
• Identify trends and recommend policy or procedure changes to improve accuracy and performance.
• Provide guidance and support to staff on coding, edits, and policy application, and maintain quality data.