Claim Edit Coding Analyst
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Job Location:
Grand Rapids, MI - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Job Summary
Applies analytical and technical skills and assist in development of solutions to prevent overpayments identified by vendors and through other means. Applies root cause analysis findings to assist with developing overpayment prevention solutions and assist implementation efforts within Priority Health. Works with vendors and other key business areas to address effectiveness of overpayment prevention solutions and identify potential solution enhancements as necessary. Also may be responsible for stop loss analysis.
Essential Functions
Coordinate with vendors to review findings and identify methods to increase claims payment accuracy and integrity.
Ability to manage and resolve conflicting points of view from providers and internal departments (includes appeals to health plan for Payment Integrity initiatives).
Analyze results of ongoing leakage and prevention monitoring to identify inefficiencies and improve solution effectiveness.
Coordinate and support activities related to vendor contracts. Manage proper controls for vendor invoicing validation reconciliations and adjustments. Prepare check requests for vendor payments.
Coordinate with other departments as needed to accomplish crossdepartmental projects and/or goals.
Analyze and review initial subsequent and or final filings to ensure submissions received are covered and eligibility requirements are satisfied per the groups stop loss policy (SPD stop loss policy fee disclosure).
Examine claims for stop loss eligibility including verifying stop loss coverage eligibility (knowledge of plan eligibility requirements including FMLA MLOA COBRA).
Qualifications
Required
- Associates degree or equivalent preferably in a health or business-related degree
- 2 years of relevant experience Health plan operations experience to include end to end claims operations and processes.
- Experience with root cause analysis.
Preferred
Bachelors Degree preferably in a health or business-related degree
CRT-Professional Coder - AAPC American Academy of Professional Coders Upon Hire
CRT-Coding Specialist (CCS) - AHIMA American Health Information Management Association Upon Hire
CRT-Coding Specialist Certified-Physician Based (CCS-P) - AHIMA American Health Information Management Association Upon Hire
CRT-Registered Health Information Administrator (RHIA) - AHIMA American Health Information Management Association Upon Hire
CRT-Registered Health Information Technician (RHIT) - AAPC American Academy of Professional Coders Upon Hire
About Corewell Health
As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement - to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!
Optional identity theft protection home and auto insurance pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Continuing Care - 1239 E Beltline Ave NE - Grand RapidsDepartment Name
Payment Integrity Planning and Implementation - PH Managed BenefitsEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
8 a.m. to 5 p.m.Days Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.
An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Required Experience:
IC
Key Skills
- ArcGIS
- Intelligence Community Experience
- GIS
- Python
- Computer Networking
- Data Collection
- Intelligence Experience
- R
- Relational Databases
- Analysis Skills
- Data Management
- Application Development
About Company
Corewell Health is committed to granting equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status
