Healthcare Services Analyst I

Employment Type

Full-time

Exempt or Non-Exempt

Exempt

Job Summary

Pay Range: $42,000 - $78,000

Note: Individuals typically begin between the minimum to middle of the pay range

Serves as the entry level position for the Healthcare Service Analyst job family. Employees in this position will gain the necessary knowledge, skills and competencies to research and respond to issues related to claim processing, new/revised reimbursement policies, benefits, and contracts. Learn how to load and review new codes, update pend resolutions. This employee receives direction from the Manager and or unit coordinator(s) and will develop a working knowledge of HMSA's business as well as medical, benefit, contracting, and reimbursement policies/edits. Learns to analyze and present large amounts of data clearly.

Minimum Qualifications

• Bachelor's degree or equivalent combination of education and work experience.
• One year related work experience.
• Effective verbal, written communication skills
• Excellent organizational and analytical skills
• Good working knowledge of Microsoft Office applications.
  
  
  

Duties And Responsibilities

• Research and Analysis:
• Research and respond to low complexity internal and external inquires.
• Use a variety of resources including, but not limited to on-line information files and databases, peer guidance, interviews with internal departments including clinical consultants, other Blue Cross/Blue Shield Plans and vendors.
• Benefit and policy analysis & implementation:
• Learns to assess business impact of new benefits, changes in medical or reimbursement policies/guidelines and tactics assigned in strategic planning.
• Learns to conduct cost/benefit analysis of claims processing. Extract and analyze data using SQL, MicroStrategy and/or other tools as available.
• Develop documentation, including cost/benefit and business impact analysis and recommendations to implement and/or improve claims processing.
• Update and create CES pend resolutions.
• Drive implementation of changes through writing of Work Intake Form, participation in multi-department meetings, contribution and review of requirements, validation of test cases, and post-implementation monitoring.
• Focus on low complexity project implementations and pend resolution updates.
• New Code Implementation:
• With the guidance of the Healthcare service analyst II, learns how to load new codes, downloading, processing and importing new codes (CPT, HCPC, ICD-10, etc.).
• Prepare and submit files for review and configuration implementation.
• Review new codes in assigned categories, work with Medical Management and Configuration to ensure appropriate claims processing/editing based on new code review.
• Post-implementation trends and workflow improvements:
• Learn how to support audits of implemented policies and completed projects.
• Identify and investigate areas involving cost increases, uncontrolled payments and/or inequitable payments.
• Identification and resolution of issues and trends as a result of researching and responding to implementation requests, problem reports, and inquiries.
• Develop clear, concise documentation complex business scenarios. This documentation will be used to develop policy/project systems and workflow requirements.
• Continuing Education:
• Attends and successfully completes HMSA and Continuing Education training classes as assigned.
• Other duties as assigned.