Claims Implementation Analyst

Healthfirst; Town of Texas (WI); On-site; USD 49,000 - 75,000; Full time

Job summary

A leading healthcare company is seeking a Claims Implementation Analyst to analyze claims configurations and ensure the accuracy of implementations. The role involves project management, data analysis, and collaboration with various departments to enhance operational efficiency. Ideal candidates will have a mix of healthcare experience and technical skills, especially in medical coding and database management.

Benefits

Medical, dental, and vision coverage

401k contributions

Incentive and recognition programs

Qualifications

• Experience in claim or data analysis in managed care.
• Proficient in medical terminology and coding (CPT4, ICD10).
• Experience with Excel creating formulas and pivot tables.

Responsibilities

• Analyze contract terms and prepare fee schedules.
• Responsible for overall success of implementations.
• Develop and maintain reporting tools and processes.

Skills

Data analysis

Medical coding

Project management

Education

High School Diploma or GED

Bachelor's Degree

Tools

Microsoft Excel

Microsoft Access

Crystal Reports

Job description

Join to apply for the Claims Implementation Analyst role at Healthfirst

22 hours ago Be among the first 25 applicants

Join to apply for the Claims Implementation Analyst role at Healthfirst

The Claims Implementation Analyst is responsible for assisting in analyzing, implementing and reporting of required claims configuration business rules. The Implementation Analyst will assist management by developing and maintaining reporting tool and processes, querying and analyzing data, identifying root causes, recommending and supporting decision making. The Implementation Analyst owns project goals by developing project plans, establishing deadlines, monitoring milestone completion, providing timely reporting of issues that impact progress and resolving conflicts. This includes documenting and prioritizing assignments. This is a fast-paced and rapidly growing environment.

Duties & Responsibilities

• Analyze contract terms, prepare fee schedules and accurately document file changes into the claims processing system
• Research and identify published updates to payment methodologies, fee schedules and claims editing policies from Medicare, Medicaid, and third-party sources.
• Responsible for the overall success of implementations including applicable testing and results verification before sign-off and Production.
• Assist in the on-going audit of configurations for new and existing claims business rules within the claims processing system.
• Identify claims configuration and contract implementation defects and improve departmental performance by supporting quality, operation efficiency and production goals thru reporting.
• Develop and maintain new and existing reporting tools, databases and processes.
• Create and maintain scripts/cases to meet requirements of functional specifications and ensure proper system functionality and quality outcomes including claims configuration, provider set up, reimbursement methodology and core claims system changes.
• Perform training and quality assurance on mass claim adjudications and automated data load processes.
• Query and manipulate claims configuration and claim data to root cause, trend, summarize findings and offer recommendations.
• Work departmentally and interdepartmentally to recommend and implement modifications to existing claims configuration audits and claim reporting functions.
• Review technical specifications to ensure the Claims Configuration Department business requirements are adequately implemented based on technical planning documents.
• Ensure post implementation accuracy of claims configuration implementations and mass claim adjudication projects.
• Recommend changes to address deficiencies and/or further improve and streamline performance based on analysis findings.
• Prepare routine reports as needed (financial, quality, production, operational efficiency, etc.).
• Track and report updates on individual work assignments and other projects within established timeframes
• Assess and prepare to address the operational impacts, workflow, and training issues of the assigned project(s).
• Complete other projects and duties as assigned.
  
  

Minimum Qualifications

• Managed care, commercial health plan (or other healthcare related) experience where you have performed claim or data analysis.
• Experience gathering and communicating business requirements in a simple and easy to understand manner to other staff.
• Proficiency in medical terminology, medical coding (CPT4, ICD10, and HCPCS), provider contract concepts and common claims processing/resolution practices.
• Experience in Microsoft Excel creating formulas and pivot tables and in using macros and the v-LOOKUP function.
• Experience creating databases and reports using Microsoft Access or other similar database software.
• Experience using report writing tools, i.e. Crystal Reports or SAS.
• Experience creating presentations in Microsoft PowerPoint.
• Experience analyzing data, data mining, managing projects and identifying trends.
• High School Diploma or GED from an accreditedschool.
  
  

Preferred Qualifications

• Experience with facility reimbursement methodologies (i.e. Diagnostic Related Groups, DRG; Ambulatory Payment Classification, APC; or Ambulatory Patient Group, APG, etc.).
• Understanding of payment and billing principles for physician or other professional services (i.e. ancillary, behavioral health, Long Term Care, etc.).
• Experience managing reports in Microsoft Outlook or other communication base systems in order to optimize utilization.
• General understanding of software design and development.
• Ability to communicate clearly in written and verbal form.
• Ability to create effective job aides and review them with key stakeholders at multiple levels of the department and organization.
• Analyze current and potential systems and serve as a resource and subject matter expert (SME) on all aspects of project plan development to support business strategies.
• Assist in the development of process and system efficiency to reduce the number of exceptions and to facilitate or influence change, ultimately improving our competitiveposition and/or optimal performance.
• Ability and willingness to handle increasing workload and responsibility.
• Ability to solve problems under time pressure, with frequent interruptions. Capability of multi-tasking including strong organizational and time management skills.
• Experience with MHS and/or MACESS systems a plus.
• Knowledge of Medicare and Medicaid programs and reimbursement methodologies a plus.
• Knowledge of healthcare claims processing practices in a managed care setting a plus.
• Bachelor's Degree from an accredited institution.
  
  

Compliance & Regulatory Responsibilities: N/A

License/Certification: NA



Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $57,400 - $78,030
• All Other Locations (within approved locations): $49,800 - $74,120
  
  

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

• The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Information Technology

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at Healthfirst by 2x

Get notified about new Implementation Analyst jobs in Texas, United States.

e-Service Chat Representative - 100% Remote

Implementation Specialist (Remote Position)

Technical Support Analyst / Customer Support Rep | 100% Remote | Perfect Engilsh Required | Construction SaaS | CLUE (getclue.com)

Business Solutions Analyst - ERP Implementation

Texas, United States $30,000.00-$40,000.00 4 hours ago

Implementation Specialist - Fully Remote

IT Business Systems Analyst - ScriptMed - Remote

administrative assistant sr, Northeast (Remote - U.S.)

Girlstown USA, TX $28.65-$48.61 2 weeks ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.