Benefits Configuration Analyst

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Peak Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.

📋 Description

• 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.

🎯 Requirements

• 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. • Bachelor’s degree in health information, healthcare, or related field preferred. • 6 years’ experience in health insurance and benefit design. • Knowledge of federal and state insurance guidelines with CMS and others. • Proficiency with Microsoft Office.

🏖️ Benefits

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