Sr Health Plan Config Analyst Job Listing at MedStar Medical Group in MD (Job ID req37895)

Description

This role will be responsible for analyzing business requirements, identifying process improvements and collaborating with cross-functional teams to implement appropriate changes. This role provides both operational support and analysis of claims and/or configuration related items. Responsible for interpreting health plan benefits, fee schedules, claims edits, provider agreement/contracts to assist third party vendor(s) with update and maintenance of core claim and ancillary systems. The Analyst will assist with UAT and post validation of benefits and pricing to ensure successful configuration, integration, and accurate and timely payment of claims. They will have overall responsibility for complex and strategic functional design requirements, configuration, integration testing and issues resolution. This role will be primarily responsible for the upkeep and maintenance of all configuration policies and procedures to ensure the accuracy of all configuration activities. .
Education

• Bachelor's degree In Healthcare Administration, Finance, Information Technology, Business Administration related field required

• 5-7 years experience in working in a health plan or managed care setting specifically in Claims, Configuration, Customer Service and Enrollment required

• Certified Professional Coder preferred

• An in-depth understanding of national reimbursement mechanisms as well as local regulatory environment.
• Strong understanding of operational activities around claims, enrollment, call center, utilization management, etc. related data.
• Database experience (SQL coding experience preferred) with ability to access and manipulate large amounts of complex to produce meaningful and useful reports for senior management.
• Extensive knowledge of payer reimbursement policies, state and federal regulations and applicable industry standards.
• Prior experience in medical billing, claims auditing and claims analysis.
• Ability to convey verbal and written information effectively.
• Ability to follow verbal and written instructions.
• Verbal and written communication skills.
• Computer skills preferred.