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Come join our Peak Health team at WVU Medicine as a Benefit Configuration Analyst contributing to the foundation for an innovative, new health plan. This position will report to the Benefits Configuration Leadership, playing a unique and important role in our mission to change healthcare for the better.
This role will review, implement and test new plan designs as well as update existing benefit plans via business requirements while working with IT for technical solutions. The Benefits Team will analyze and update CPT, HCPC and ICD-10 coding along with ensuring compliance with CMS and other insurance governance agencies using expert data analysis.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Associate degree in health information, healthcare, or related field AND One (1) year of experience in health insurance, medical coding, claims processing or related field.
OR
2. High School Diploma or equivalent AND Three (3) years of experience in health insurance, medical coding, claims processing or related field.
PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor's degree in health information, healthcare, or related field.
EXPERIENCE:
1. 6 years' experience in health insurance and benefit design.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Test and maintain health insurance benefit plans in the company's systems, ensuring accuracy and compliance with regulatory requirements.
2. Conduct regular audits and reviews of benefit configurations to identify discrepancies, inconsistencies, or errors.
3. Resolve configuration errors in a timely manner and document changes.
4. Work closely with IT teams to ensure seamless integration of benefit configurations into the company's technology platforms.
5. Maintain comprehensive documentation for benefit configuration, ensuring that processes and procedures are well-documented.
6. Evaluate and validate all medical billing codes, various coding services and align to accurate benefit coding.
7. Perform audits on all clinical documents and prepare coding to provide support to all services.
8. Perform research on various coding methods and facilitate all plans to resolve all discrepancies and coordinate with all clinical and non-clinical groups to manage documents according to required guidelines.
9. Administer review of professional billing systems and perform research to resolve all coding errors and evaluate all claims work queues.
10. Review procedure code master file and evaluate authenticity of all entries and evaluate all through efficient usage of codes.
11. Analyze and maintain all code master files for all inappropriate codes and inform staff for same and collaborate with staff to resolve all coding issues and ensure accuracy of same.
12. Perform testing of coding and policy changes via reports, claim adjudication and other testing software.
13. Manage and resolve all discrepancies in entry of codes and maintain knowledge on all procedural codes and reimbursement plans and prepare reports for all coding guidelines.
14. Maintain knowledge and compliance of CMS (Center for Medicare Services) guidelines and coding/billing processes. Ensure compliance with other insurance governance agencies.
15. Participate in and support all training in regard to new benefit designs or benefit changes as the result of CMS or other insurance regulations.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Prolonged periods of sitting and standing.
2. Visual strain may be encountered in viewing computer screens and written material.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Standard office environment.
2. Some travel may be required to offsite meetings.
SKILLS AND ABILITIES:
1. Strategic and Independent thinking.
2. Demonstrated knowledge of federal and state insurance guidelines with CMS and others.
3. Excellent written and oral communication.
4. Demonstrated ability to build and retain relationships.
5. Proficiency with Microsoft Office.
6. Attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
PHH Peak Health Holdings
Cost Center:
529 PHH Clinical Integration