About this role
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.
- 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.
Benefits
- Health insurance
- Paid time off
- Professional development
- Some travel may be required to offsite meetings