Role Overview

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

Peak Health

Open Positions (1)

Data

Benefits Configuration Analyst