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Operations Systems Analyst

Apex Systems

This is a Full-time position in Houston, TX posted February 20, 2021.

Summary the role is responsible for accurate and timely maintenance of provider information on all claims and provider databases. It also validates that provider information entered on databases adheres to business policies and state requirements. Duties and responsibilities Load new providers contracted to our network in QNXT and Cactus. Execute changes in provider data and contracts as requested by Provider Network Management team. Create contract records for out of network providers to properly adjudicate claims received. Research and respond to inquiries related to provider data and affiliation status. Loads and maintains provider information in an accurate and timely manner to meet department’s standards of turnaround time and quality. Monitors pended claims and work queues to update appropriate systems. Identifies claims impacted by configuration changes done in the system and sends reports to the claims administration department for reprocessing. Education HS Diploma or GED required Experience 1 – 3 years in Managed Care, provider data and claims processing required Knowledge and skills Knowledge of managed care business practices as it pertains to providers, credentialing and contracts as required by the Health Plan. Additional preferred knowledge includes provider contract configuration, TX Medicaid, Master Provider File. Written and verbal communication, detailed analytical skills and organizational skills ability to manage time with competing priorities EEO Employer Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at or