by Irma Moore | Apr 10, 2024 | Uncategorized
- Represents assigned business system or business process as a subject matter expert in business requirements, system specifications, process flows, process change and/or project management
- Provides leadership to the business in the identification and adoption of operational best practices and standard operating procedures as it relates to assigned business system or business process
- Independently researches, determines root cause and collaborates with others to resolve complex business and technical issues and customer inquiries.
- Provides prompt and thorough resolution for client and/or member satisfaction
- May facilitate testing for new or improved systems or processes including creation of a test plan, identifying test cases, and performing or leading User Acceptance and Joint Cycle Testing
- May provide guidance, mentoring, and work direction to others on the team
- Other duties as assigned
Minimum Qualifications
- Bachelor’s degree in business administration, IT or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
- 5 years of work experience in business analysis, project management, and/or process improvement to include:
- 3 years of functional experience in at least one of the specific areas for position (e.g., claims, eligibility, product, benefits, implementations or related area)
- Must be eligible to work in the United States without need for work visa or residency sponsorship
by Irma Moore | Apr 10, 2024 | Uncategorized
- Manages and develops budgets to support quality and performance metrics.
- Develops and implements short- and long-term plans, and objectives to improve the quality of documentation and coded data to ensure appropriate revenue.
- Assesses data development and collection according to organization needs to support revenue cycle initiatives and key performance indicators.
- Provides oversight for the collection and submission of audit data.
- Maintains knowledge of coding and billing requirements and regulatory changes and acts as a resource to the coding and health information management staff.
- Analyzes and interprets coding data to identify problems or trends.
- Oversees the development and delivery of educational sessions to coding team, medical staff and other clinical teams.
- Establishes and continuously assesses the effectiveness of the internal controls within the unit and compliance with University policies and procedures. Ensures employees are trained on controls within the function and on University policy and procedures.
This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.
MINIMUM QUALIFICATIONS
- Bachelor’s Degree in related field
- Minimum 7 years of relevant experience
- RHIT or RHIA Certification in a relevant specialty or field
- Knowledge of business and management principles
- Ability to direct, manage, implement, and evaluate department operations.
- Ability to establish department goals and objectives that support the strategic plan.
- Ability to effectively plan, delegate and/or supervise the work of others.
- Ability to lead, motivate, develop and train others.
by Irma Moore | Apr 10, 2024 | Uncategorized
- Posts Accounts Payable deposits
- Processes electronic 835’s and manual payer EOBs, including the posting of insurance allowable, patient portions, denials, adjustments, contractual allowances, recoups and forward balancing
- Interprets Explanation of Benefits (EOB) remittance codes and applies correct denial codes.
- Balances and closes payment batches timely
- Navigate websites to obtain EOBs
- Performs special projects and other duties as assigned
Education and Experience Requirements
- High School Diploma or Equivalent
- At least two (2) years of experience posting insurance payments in a healthcare setting
- At least two (2) years of experience reading insurance Explanation of Benefits (EOB) statements preferred
Knowledge, Skills, and Abilities
- Knowledge of insurance payer types
- Knowledge of Explanation of Benefits (EOB) statements
- Strong balancing and reconciliation skills
- Strong 10 Key calculator skills
- Strong oral, written, and interpersonal communication skills
- Strong mathematical skills
- Strong time management skills
- Strong organizational skills
- Ability to read, understand, and apply state/federal laws, regulations, and policies
- Ability to remain flexible and work within a collaborative and fast paced environment
- Ability to communicate with diverse personalities in a tactful, mature, and professional manner
by Irma Moore | Apr 10, 2024 | Uncategorized
- Reviews prospective and current learner documents to verify accuracy eligibility and completeness, necessary to draw Title IV and military funds.
- Evaluates the accuracy of completed verification, professional judgment, C code reviews, Unusual Enrollment History (UEH), ISIR rejections, and resolves conflicting data.
- Determines accuracy of packaging and disbursement.
- Utilizes multiple databases and technology including Common Origination & Disbursement (COD), National Student Loan Data System (NSLDS), and Central Processing System (CPS) to ensure compliance with institutional and federal regulations.
- Participates in the successful implementation of other functional projects as they arise.
Qualifications and Education Requirements
- A high school diploma or general equivalent is required.
- At least one year of experience in a professional environment that is highly regulated including finance, higher education, or medical field is required.
- Demonstrated knowledge of Federal Student Aid and/or military funding is required.
- Demonstrated proficiency in Microsoft Office applications is required.
- Demonstrated experience in an institution of higher learning or student funding is preferred.
by Irma Moore | Apr 10, 2024 | Uncategorized
This position specializes in the analysis and application of intermediate level benefit plan design requirements. A successful Analyst will ensure a high level of quality and accuracy through benefit configuration, test execution and validation efforts while serving as a subject matter expert on benefits and claim adjudication system coding setup.
Job Description
- Analyzes new business requirements for benefit design changes to establish the appropriate solution.
- Complies with standards set forth regarding benefit design and configuration including but not limited to Health Insurance Portability and Accountability Act of 1996 (HIPAA) and National Council for Prescription Drug Programs (NCPDP).
- Maintains technical documentation based on standard operating procedures.
- Partners with various teams to analyze customer specific requirements and configuration and translate those into technical design specification and data flow from which programs are developed and coded.
- Actively participates in and contributes to daily communications, team meetings and project/issue resolution.
- Responsible for accurate management of plan benefits coding changes, test execution and validation efforts of plan benefit design requests.
- Maintains customer documentation that validates configuration.
- Efficiently and effectively distributes tasks, using clear and concise instructions and expectations.
- Completes deliverables independently and within an agile team setting.
- Other duties as assigned.
Responsibilities
- 2+ years of experience in benefit plan configuration/analysis.
- Experience with adjudication processes (FirstRx preferred), analyzing benefit plan design and system application.
- Advanced working knowledge of Microsoft office products (specifically Word, Access, Excel), including running queries and macros.
Recent Comments