• Job Description

  Req#: JR23-25644
  Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position.
  
  Come join our Peak Health team at WVU Medicine as a Benefit Configuration Specialist, contributing to the foundation for an innovative, new health plan. This position will report to the Benefits Configuration Manager, playing a unique and important role in our mission to change healthcare for the better.
  
  This role will review and implement new plan designs as well as update existing plans via system configuration. The Benefits Team will analyze and update CPT, HCPC and ICD-10 coding along with ensuring compliance with CMS and other insurance governance agencies using expert data analysis.
  
  MINIMUM QUALIFICATIONS :
  
  EDUCATION, EXPERIENCE, CERTIFICATION, AND/OR LICENSURE:
  
  1. Associate degree in health information, healthcare, or related field AND Three (3) years of experience in health insurance, medical coding, claims processing or related field.
  
  OR
  
  High School Diploma or equivalent AND Five (5) years of experience in health insurance, medical coding, claims processing or related field
  
  PREFERRED QUALIFICATIONS :
  
  EDUCATION, CERTIFICATION, AND/OR LICENSURE:
  
  1. Bachelor's degree in health information, healthcare, or related field
  
  EXPERIENCE:
  
  1. 6 years' experience in health insurance and benefit design.
  
  CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
  
  1. Configure and maintain health insurance benefit plans in the company's systems, ensuring accuracy and compliance with regulatory requirements.
  
  2. Collaborate with internal stakeholders, including product management and actuarial teams, to understand benefit plan specifications and updates.
  
  3. Conduct regular audits and reviews of benefit configurations to identify discrepancies, inconsistencies, or errors.
  
  4. Implement corrective actions and work closely with relevant teams to address and resolve configuration issues.
  
  5. Work closely with IT teams to ensure seamless integration of benefit configurations into the company's technology platforms.
  
  6. Develop and maintain comprehensive documentation for benefit configurations, ensuring that processes and procedures are well-documented.
  
  7. Evaluate and validate all medical billing codes, various coding services and align to accurate benefit coding.
  
  8. Perform audit on all clinical documents and prepare code to provide support to all services.
  
  9. Perform research on various coding methods and facilitate all plans to resolve all discrepancies and coordinate with all clinical and non-clinical groups to manage documents according to required guidelines.
  
  10. Administer review of professional billing systems and perform research to resolve all coding errors and evaluate all claims work queues.
  
  11. Prepare and maintain procedure code master file and evaluate authenticity of all entries and evaluate all through efficient usage of codes.
  
  12. Analyze and maintain all code master files for all inappropriate codes and inform staff for same and collaborate with staff to resolve all coding issues and ensure accuracy of same.
  
  13. Perform testing of coding and policy changes via reports and claim adjudication.
  
  14. Manage and resolve all discrepancies in entry of codes and maintain knowledge on all procedural codes and reimbursement plans and prepare reports for all coding guidelines.
  
  15. Maintain knowledge and compliance of CMS (Center for Medicare Services) guidelines and coding/billing processes. Ensure compliance with other insurance governance agencies.
  
  16. Provide consultation for business solutions and communicate effectively with all levels of the organization.
  
  17. Train junior staff in all coding requirements and provide all information as it pertains to insurance regulations.
  
  18. Document and train staff in regards to new benefit designs or benefit changes as the result of CMS or other insurance regulations.
  
  PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  
  1. Prolonged periods of sitting and standing.
  
  2. Visual strain may be encountered in viewing of computer screens and written material.
  
  WORKING 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.
  
  1. Standard office environment
  
  2. Some travel may be required to offsite meetings
  
  SKILLS AND ABILITIES:
  
  1. Strategic thinking
  
  2. Demonstrated knowledge of federal and state insurance guidelines with CMS and others
  
  3. Excellent written and oral communication
  
  4. Demonstrated ability to build and retain relationships
  
  5. Proficiency with Microsoft Office
  
  6. Attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.
  
  Additional Job Description:
  
  Scheduled Weekly Hours:
  40
  
  Shift:
  
  Exempt/Non-Exempt:
  United States of America (Exempt)
  
  Company:
  PHH Peak Health Holdings
  
  Cost Center:
  2902 PHH Claims Operations

• About the company

  The best remote jobs for you

Notice