Plan Benefits Systems Analyst
The System Support & Development Plan Builder will create, maintain and update the system as necessary for claims adjudication.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Develop and implement plan construction for new plan or client
- Implement changes and updates to existing plan builds.
- Review daily reports to identify system improvement and deploy solutions
- Review and resolve daily claims issues related to the system build
- Work with team members to identify and resolve system issues
- Maintain provider records for network and non network providers
- Interact with internal and external clients as necessary
- Communicate with other departments on changes that impact their processes
- Set up and/or review ERA and EFT remittances
- Review and validate fee schedule rates
- Work adhering to US regulatory and Quality System requirements (21 CFR 820, etc).
- This position assumes and performs other duties as assigned.
QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
- Plan Building experience or 3+ years Claims Processing experience
- CPT/HCPCS/ICD10 knowledge
- Excellent communication skills (written and verbal)
- Must be able to work independently as well as within a team
- Must be able to work in a fast paced environment
- Must be able to multitask and reprioritize as necessary
- SQL or Access knowledge helpful but not required
- Knowledge of Pricing Methodologies
- Must be organized and detail oriented
EDUCATION and/or EXPERIENCE
- High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.
WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this Job, the employee is regularly required to sit; use hands to handle or feel; talk; and hear.
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.