Delta Health Systems

Analyst

• Provide ongoing technical and operational support for the Mphasis Javelina platform, including ID cards, EOBs, accumulator data loads, historical claims data loads, and related processes
• Troubleshoot system, data, file, and production issues and coordinate resolutions with internal teams and external vendors
• Support modernization, conversion, enhancement, testing, validation, and deployment of legacy AS400 and finance applications using C#/.NET
• Support recurring healthcare reporting and file processes, including CMS Mandatory Reporting, Limited Liability Reporting, Anthem Dual Coverage files, and other operational reporting
• Identify opportunities to automate manual reporting, data processing, validation, and recurring operational activities
• Support accumulator and claims data conversions for new group implementations, including validation and reconciliation
• Maintain a centralized repository of reporting and operational SQL queries with documentation and governance standards
• Develop technical and operational documentation, process flows, business rules, dependencies, validation procedures, troubleshooting steps, and escalation procedures
• Create and maintain operational runbooks and knowledge resources
• Partner with business users, operations, IT, and vendors to understand requirements, resolve issues, and implement process and system improvements

Application Modernization Analyst

Billing Specialist

• Review and reconcile client eligibility and payments.
• Determines active, retiree, and COBRA eligibility based on plan sponsor plan provisions.
• Processes enrollment eligibility files and completes enrollment edits in system queues.
• Enter new employees and dependents into the system and make changes to existing records as required.
• Ensure identification cards are ordered correctly and timely according to plan sponsor and company guidelines.
• Post & reconcile client payments.
• Process vendor disbursements and reconciles payments according to vendor requirements and company guidelines.
• Disburse end-of-the-month reports to clients as required.
• Completes the review of and responds to vendor discrepancy reports as assigned.
• Interprets and communicates COBRA and HIPAA regulations.
• Handles self-pay administration according to plan provisions and guidelines.
• Answers email and call inquiries from participants, clients, vendors and local unions.
• Provides customer service and maintains effective relationships with clients, participants, agents, and brokers.
• Update and maintain Client Policy and Procedure document.
• Adheres to and is responsible for the understanding of company eligibility policies and procedures and resources.
• Meets department production and quality metrics.
• Participates in and contributes to mandatory department meetings, training, and company events.
• Completes company, department, or plan sponsor special projects.
• Follows company attendance policy and adheres to provisions in the collective bargaining agreement.
• Upholds and exemplifies company values.
• Performs other duties as assigned.
• Review and process all internal and client specific weekly and/or monthly reports.
• Email and Group folder organization.

Billing & Eligibility Coordinator

Manager

• Supervise assigned staff in a responsible manner including training, planning, directing work, appraising performance, rewarding, and addresses complaints.
• Mentors, educates, and provides corrective action, performance improvement plans, and disciplines staff when necessary.
• Participants in the interview process for the hiring of new staff when necessary.
• Conducts monthly 1:1, quarterly, and annual performance reviews with staff to discuss productivity, issues, concerns, quality, and expectations.
• Responds to staff, internal and external customer inquiries, and provides resolution to issues accordingly.
• Evaluates department performance and takes corrective action, when necessary.
• Ensures overall inventory and assigned queues and processes are handled within department guidelines.
• Reviews department reports for accuracy, thoroughness, and timeliness and adjusts measurements when necessary.
• Interprets plan provisions and make recommendations for system administrative improvements to meet customer expectations.
• Develop relationships with other departments to ensure interdepartmental communication is effective.
• Develops and maintains effective relationships with customers and their affiliated partners.
• Manages within established budget of unit.
• Collaborates with information services on system enhancements, providing documentation and justification for improvements to system for proper claims flow.
• Assists Client Services with client requests to meet customer expectations, requests, and deadlines.
• Participate in new business implementations.
• Enforces, adheres to, and follows department policies and procedures and Collective Bargaining Agreements.
• Participates in and contributes to department meetings and continual training.
• Represents company at existing and prospective customer meetings.
• Upholds and exemplifies company values.
• Must occasionally travel to client locations.

Application Modernization Analyst

Billing & Eligibility Coordinator

Claims Manager