Commercial Analyst
S&S Activewear
ERPSQL
Systems Configuration Analyst
Geisinger
full-time
Posted on:
Location Type: Remote
Location: Remote • Pennsylvania • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Review provider contracts to ensure accurate coding and proper setup of payment terms within the claims processing module
- Contribute to special projects focused on implementing industry-standard or government-mandated coding changes that impact provider payments
- Assist with ongoing configuration, management and oversight in Facets or other systems related to Benefits, Finance, Pricing, Billing and Dunning, Consumer Driven, Provider set up, Claims and Workflow
- Configure and manage specified programs, products and services in one or more major configuration areas; ensure continued operational functionality and accuracy of Facets and supporting systems
- Review and interpret benefit documents to configure benefits at all levels of detail; design, configure and test benefits and resolve issues
- Manage creation of member ID cards and member benefit documents
- Responsible for all aspects of Finance Configuration including vendor capitation, group set up, premium billing invoices, and managing the dunning process
- Initiate proper financial terms and accurate setup of contractual arrangements in the pricing module
- Interface with Provider Network Management and Contract Administration for contract interpretation and pricing agreements
- Develop communication methods and standards for dissemination of pricing configuration information
- Create and support processes for correct provider set up and maintenance; design, create, manage and issue resolution of Workflow rules for claims automation
- Configure eligibility process, configuration migration utility process, letter generation and configuration support for consumer driven products
- Partner with other teams to resolve configuration needs; train team members and maintain documentation; assist in configuration audits
Requirements
- High School Diploma or Equivalent (GED)- (Required)
- Minimum of 4 years-Relevant experience* (Required)
- Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years)
- Strong healthcare billing and claims experience
- Solid understanding of CMS1500 and UB04 claim forms, CPT/HCPC codes, Revenue codes, and ICD-10 coding
- Experience with Facets or other systems related to Benefits, Finance, Pricing, Billing and Dunning, Consumer Driven, Provider set up, Claims and Workflow
- Experience with Finance Configuration including vendor capitation, group set up, premium rate tables, broker fees and commission schedules
- Experience designing, configuring and testing benefits according to Health Plan and industry coding schemes
- Experience creating workflow rules and automation for claims processing
- Skills: Computer Literacy, Critical Thinking, Interpersonal Communication, Mathematics, Professional Presentation, Working Independently
Benefits
- Healthcare benefits for full time and part time positions from day one
- Vision insurance
- Dental insurance
- Benefits for domestic partners
- Work from home (Pennsylvania resident) flexibility
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
codingconfiguration managementclaims processingbenefit configurationfinancial configurationworkflow automationCPT codesHCPC codesICD-10 codingCMS1500
Soft skills
critical thinkinginterpersonal communicationmathematicsprofessional presentationworking independently
Certifications
High School DiplomaGED
