Provide analytical support and leadership for key Claims-related projects
Define clinical and payment policy requirements for configuration of clinical editing system
Conduct research for potential new reimbursement policy claim edits
Analyze claim results for potential errors attributed to various factors
Ensure all clinical and payment policy analysis is prepared and approved prior to implementation
Provide input to UAT and conduct post implementation validation
Create effective communication materials summarizing findings for stakeholders
Monitor configuration and Claim SOPs for accuracy
Assist in development of policies and procedures for claims processing

Bachelor’s degree or equivalent years of relevant work experience
Minimum of three (3) years of health plan experience or equivalent experience with provider coding and claim payment policies
Experience working with clinical editing software is preferred
Advanced proficiency in Microsoft Suite: Word, Excel, Access, and Visio
Strong computer skills and abilities in Facets
Understanding of claims operations, configuration, and clinical editing related to managed care
Knowledge of CPT, HCPCs and ICD-CM Codes, including ICD-9/ICD-10, CPT, HCPC, REV, DRG and Rug
Knowledge of HIPAA Transaction Codes

Payment Cycle Analyst II

Key skills