SPARKS, Nevada
Cincinnati, Ohio
Wilmington, North Carolina
Cincinnati, Ohio
Cincinnati, Ohio
Cincinnati, Ohio
Waterford, New York
North Tonawanda, New York
Posted: 21-Jan-23
Location: Irving, Texas
Salary: Open
Categories:
Internal Number: 10245502
Summary:
The Business Configuration Analyst II will work in conjunction with Auditing, Member Services, Complaints and Grievances, Provider Data, Utilization Management, Claims and other operational departments. The position will be responsible for gathering comprehensive business requirements and translating them into configuration design and implementation. A thorough understanding of healthcare systems, data collection, analysis, strong organizational and record keeping skills are required.
- Benefit research, design, configuration, testing and implementation for multiple product lines including Medicare, Commercial, Exchange and Tricare.
- Attend management meetings in place of Configuration Management as needed
- Research and resolution of defects related to UB04 and HCFA claims
- Review, validate and load all codes for claims adjudication (ICD10, CPT9, HCPCS, Modifiers, HIPPS, etc.)
- Maintain accuracy of clinical editing software (ex. Claim Check)
- Fall out management for external pharmacy claims data via claims batch load.
- Demonstrate the ability to locate, research, comprehend, and appropriately apply 3rd party payer rules and regulations; analyze and resolve complex coding related claim denials in a manner that ensure accurate and optimal reimbursement
- Demonstrate clear and concise oral and written communication skills
- Demonstrate strong decision making and problem-solving skills; personal initiative to keep abreast of new developments in coding updates, technology, research, regulatory data; detail oriented and ability to meet deadlines
- Ability to adjust successfully to changing priorities and workload volume
- Audit and confirm the coding of diagnoses and procedures relevant to resolve the billing/coding edits
- Review appropriate regulatory references to identify/substantiate diagnoses, procedures and modifiers that support services billed
- Implement and adhere to change management requirements through compliance, legal, operation for reporting, approval signatures, and maintenance of changes
- Works in conjunction with Business Analyst and the operational team for follow up, resolution, and trending of coding related denials and appeals
- Maintains required productivity standards
- Tracks opportunities for documentation, reimbursement and coding improvement
- Provides information and feedback daily on coding related issues, edits, denials, reimbursement trends, and coding errors to Operational Management and Medical Management
- Performs other duties as assigned
- Ability to keep confidential information as such
- Strong organizational skills and ability to manage multiple competing projects and deadlines
- Ensures internal compliance with all Federal and State Regulations
Requirements:
- Bachelor's Degree required
Work Type:
Full Time
