Benefits Configuration Analyst

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🕒 Junho 4

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WVU Medicine

SiteLinkedInTodas as Vagas

10.000+ funcionários

⚕️ Seguro de Saúde

Healthcare Insurance

WVU Medicine é um sistema de saúde abrangente afiliado à West Virginia University, fornecendo serviços médicos através de uma rede de hospitais em todo o estado da Virgínia Ocidental. O sistema inclui instalações notáveis como o J. W. Ruby Memorial Hospital, WVU Medicine Children's, e vários outros centros médicos regionais. WVU Medicine oferece uma ampla gama de serviços de saúde, incluindo tratamentos médicos especializados e avançados, como cirurgia cardíaca robótica. Também está envolvido na educação médica, pesquisa e iniciativas de saúde comunitária, enfatizando a missão de fornecer cuidados de alta qualidade às comunidades que serve.

Descrição

• Test and maintain health insurance benefit plans in the company's systems, ensuring accuracy and compliance with regulatory requirements. • Conduct regular audits and reviews of benefit configurations to identify discrepancies, inconsistencies, or errors. • Resolve configuration errors in a timely manner and document changes. • Work closely with IT teams to ensure seamless integration of benefit configurations into the company's technology platforms. • Maintain comprehensive documentation for benefit configuration, ensuring that processes and procedures are well-documented. • Evaluate and validate all medical billing codes, various coding services and align to accurate benefit coding. • Perform audits on all clinical documents and prepare coding to provide support to all services. • 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. • Administer review of professional billing systems and perform research to resolve all coding errors and evaluate all claims work queues. • Review procedure code master file and evaluate authenticity of all entries and evaluate all through efficient usage of codes. • 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. • Perform testing of coding and policy changes via reports, claim adjudication and other testing software. • 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. • Maintain knowledge and compliance of CMS (Center for Medicare Services) guidelines and coding/billing processes. Ensure compliance with other insurance governance agencies. • Participate in and support all training in regard to new benefit designs or benefit changes as the result of CMS or other insurance regulations.

🎯 Requisitos

• 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. • High School Diploma or equivalent AND Three (3) years of experience in health insurance, medical coding, claims processing or related field. • 6 years’ experience in health insurance and benefit design. • Strategic and Independent thinking. • Demonstrated knowledge of federal and state insurance guidelines with CMS and others. • Proficiency with Microsoft Office. • Attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.

🏖️ Benefícios

• Health insurance • Paid time off • Professional development • Some travel may be required to offsite meetings