5 DAYS - 8 HOURS
Config An II HP Bnft Config HP Corp A
CHRISTUS System Office
No Travel Applicable
CHRISTUS Corp Irving Offices 919 and 909 Buildings
919 Hidden Ridge
Irving, TX 75038
USView Other Locations
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Apply Now Config An II HP Bnft Config HP Corp A Job in Irving
Under the supervision of the Business Configuration Supervisor the Business Configuration Analyst II will work in conjunction with Claims, Auditing, Network, Provider Data, Utilization Management as well as other operational departments to ensure validation and quality assurance of business requirements for the configuration of the CHRISTUS Health plan. The position will be responsible for gathering comprehensive business requirements and translating them into configuration design and implementation. A thorough understanding of benefits, healthcare systems, data collection, analysis, strong organizational and record keeping skills are required.
- Benefit research, design, configuration, testing and implementation for multiple product lines.
- 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 work load 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.
- Takes initiative to query the physicians for documentation or clarification to justify services.
- Works in conjunction with Business Analyst Senior 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.
- Associates degree in Business/Health Information Services, or equivalent configuration and/or coding experience.
- Three years healthcare experience with equivalent configuration and/or coding experience; Managed Care experience preferred
- Analytic ability to organize and prioritize work to meet deadlines
- Proficient in Microsoft Office
- Excellent written and verbal skills required
- Good judgment, initiative and problem-solving abilities
- Ability to handle and resolve complex issues with little assistance
- Ability to perform multiple tasks simultaneously
- Ability to communicate effectively
- Thorough understanding of ICD9-CM, ICD10, DRG methodologies, CPT-4, Outpatient Code Editor and National Correct Coding Initiative policies
- Knowledge of Claim Check system or equivalent clinical editing systems
- Health Solutions Plus (HSP) experience preferred