Configuration Analyst I

healthonellc; Dalton (GA); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

401K (4% Match, Immediate Vesting)

Health Insurance

Flexible Spending Account

Paid Time Off

Life & AD&D Insurance

Short Term Disability

Long Term Disability

Job summary

HealthOne in Dalton, GA seeks a Configuration Analyst I to maintain data in the core claims processing system, designing benefit packages with ICD-10, CPT-4, HCPCS codes and ensuring accurate determinations across plans.

You will assist with dictionary maintenance, testing, and collaboration with internal departments, supporting client configurations, system upgrades, and problem-solving of provider and client issues.

Qualifications

• High School Diploma or GED required.
• Associates or Bachelor's degree in a business or computer-related field preferred.
• Knowledge of ICD-10, CPT4 Coding, HCPCS and medical terminology.
• Three or more years of Healthcare experience.
• Three or more years of working around claims implementation and analysis and/or claims configuration experience in any one of these areas: Provider/Provider Contracting, Clinical Benefits, Enrollment and Billing.
• Coding Certificate preferred.
• Proficiency in Microsoft Office Suite including Outlook, Word, Excel, and PowerPoint.

Responsibilities

• Assists with dictionary/master file maintenance such as research, set up and maintenance of all Diagnosis, CPT, and other medical code sets.
• Assists with updates and maintains adjudication system with defined code sets in logical order.
• Coordinates with internal departments to ensure data accuracy.
• Supports maintenance of group/benefit additions, terms, changes.
• Assists in the support fee schedule maintenance including terms, affiliations, and contract maintenance.
• Runs existing testing scripts for new and existing plans.
• Assists in the on-going evaluation of the benefit configurations within the core claim processing system for new and existing benefit plans.
• Documents the configuration of new plans as well as changes in existing plans.
• Provides feedback to Configuration Analyst II regarding feasibility and requirements for enhancements to benefit configuration.
• Provides research assistance for the resolutions of benefit issues.
• Serves as a liaison of benefit configuration to external departments.
• Collects and analyzes data to evaluate operational difficulties and makes recommendations to solve problems.
• Supports the work to troubleshoot and resolves claims that suspend in work queues for configuration intervention in the claims processing system.
• Audits files and/or batch load entries for accuracy.
• Assists in problem solving of the monthly files such as 837 Encounter File submissions and error corrections.
• Performs a variety of tasks related to the on-going maintenance and set up of client configurations with the core administrative system.
• Assists with client implementations, system upgrades and projects to improve performance.
• Participates in problem solving of provider, client, reporting or system issues.
• Potential to rotate through configuration support functions across key system areas and lines of business with the ability to develop subject matter expertise.
• Performs special projects as needed and other duties related to system and report data integrity.
• Maintains regular and predictable attendance.
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice.
• Works to encourage and promote Company culture throughout the organization.
• Other duties as may be assigned

Skills

ICD-10 knowledge

CPT-4/HCPCS knowledge

Healthcare experience

Claims analysis

Education

Associate or Bachelor's degree in business or computer-related field

Coding Certificate (preferred)

Tools

Microsoft Office Suite

Job description

MISSION

Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

VALUES

HealthOne is guided by a cultural framework that embodies our values and drives our decisions.

As a company our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. We fulfill our purpose by filtering our decisions through a PRIORITIES lens of asking, "Is what we are about to do ethical, empathetic, economical, and efficient?". By caring for PEOPLE, we are welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

JOB PURPOSE

The Configuration Analyst I support activities to maintain data within the core claims processing system using the medical classification system to design the benefit packages with proper code sets, including ICD-10, CPT-4, HCPCS for configuration. Disseminates benefit determinations to key stakeholders administering benefits (health services, configurations, etc.) throughout the organization. Serves as an integral role in the testing, analysis, and benefit configuration of new and existing plans.

ESSENTIAL JOB DUTIES

• Assists with the dictionary/master file maintenance such as research, set up and maintenance of all Diagnosis, CPT, and other medical code sets
• Assists with updates and maintains adjudication system with defined code sets in logical order
• Coordinates with internal departments to ensure data accuracy
• Supports maintenance of group/benefit additions, terms, changes
• Assists in the support fee schedule maintenance including terms, affiliations, and contract maintenance
• Runs existing testing scripts for new and existing plans
• Assists in the on-going evaluation of the benefit configurations within the core claim processing system for new and existing benefit plans
• Documents the configuration of new plans as well as changes in existing plans
• Provides feedback to Configuration Analyst II regarding feasibility and requirements for enhancements to benefit configuration
• Provides research assistance for the resolutions of benefit issues
• Serves as a liaison of benefit configuration to external departments
• Collects and analyzes data to evaluate operational difficulties and makes recommendations to solve problems
• Supports the work to troubleshoot and resolves claims that suspend in work queues for configuration intervention in the claims processing system
• Audits files and/or batch load entries for accuracy
• Assists in problem solving of the monthly files such as 837 Encounter File submissions and error corrections
• Performs a variety of tasks related to the on-going maintenance and set up of client configurations with the core administrative system
• Assists with client implementations, system upgrades and projects to improve performance
• Participates in problem solving of provider, client, reporting or system issues
• Potential to rotate through configuration support functions across key system areas and lines of business with the ability to develop subject matter expertise
• Performs special projects as needed and other duties related to system and report data integrity
• Maintains regular and predictable attendance
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
• Works to encourage and promote Company culture throughout the organization
• Other duties as may be assigned

QUALIFICATIONS

• High School Diploma or GED required
• Associates or Bachelor's degree in a business or computer-related field preferred
• Knowledge of ICD-10, CPT4 Coding, HCPCS and medical terminology
• Three or more years of Healthcare experience
• Three or more years of working around claims implementation and analysis and/or claims configuration experience in any one of these areas: Provider/Provider Contracting, Clinical Benefits, Enrollment and Billing
• Coding Certificate preferred
• Proficiency in Microsoft Office Suite including Outlook, Word, Excel, and PowerPoint

PHYSICAL REQUIREMENTS

Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

BENEFITS

• 401K (4% Match, Immediate Vesting)
• Accident insurance
• Competitive salary
• Critical Illness Insurance
• Dental Insurance
• Employee Assistance Program
• Flexible Spending Account
• Health & Wellness Program
• Health Savings Account
• Life & AD&D Insurance
• Long Term Disability
• Medical Insurance
• Paid Time Off
• Pet Insurance
• Short Term Disability
• Vision Insurance