Peak Health · 2 weeks ago
Benefit Configuration Analyst
Core, WV
Full-time
Onsite
Mid, Senior Level
6+ years expPeak Health is seeking a Benefit Configuration Analyst to contribute to the foundation for an innovative health plan. The role involves reviewing, implementing, and testing new plan designs, as well as ensuring compliance with CMS and other insurance governance agencies through expert data analysis.
Financial ServicesHealth InsuranceInsurance
Responsibilities
Test and maintain health insurance benefit plans in the company's systems, ensuring accuracy and compliance with regulatory requirements
Conduct regular audits and reviews of benefit configurations to identify discrepancies, inconsistencies, or errors
Resolve configuration errors in a timely manner and document changes
Work closely with IT teams to ensure seamless integration of benefit configurations into the company's technology platforms
Maintain comprehensive documentation for benefit configuration, ensuring that processes and procedures are well-documented
Evaluate and validate all medical billing codes, various coding services and align to accurate benefit coding
Perform audits on all clinical documents and prepare coding to provide support to all services
Perform research on various coding methods and facilitate all plans to resolve all discrepancies and coordinate with all clinical and non-clinical groups to manage documents according to required guidelines
Administer review of professional billing systems and perform research to resolve all coding errors and evaluate all claims work queues
Review procedure code master file and evaluate authenticity of all entries and evaluate all through efficient usage of codes
Analyze and maintain all code master files for all inappropriate codes and inform staff for same and collaborate with staff to resolve all coding issues and ensure accuracy of same
Perform testing of coding and policy changes via reports, claim adjudication and other testing software
Manage and resolve all discrepancies in entry of codes and maintain knowledge on all procedural codes and reimbursement plans and prepare reports for all coding guidelines
Maintain knowledge and compliance of CMS (Center for Medicare Services) guidelines and coding/billing processes. Ensure compliance with other insurance governance agencies
Participate in and support all training in regard to new benefit designs or benefit changes as the result of CMS or other insurance regulations
Qualification
Required
Associate degree in health information, healthcare, or related field AND One (1) year of experience in health insurance, medical coding, claims processing or related field
High School Diploma or equivalent AND Three (3) years of experience in health insurance, medical coding, claims processing or related field
Preferred
Bachelor's degree in health information, healthcare, or related field
6 years' experience in health insurance and benefit design
Company
Peak Health
Peak Health is a health insurer that offers health insurance.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Ben Gerber
Chief Executive Officer
Brian Stilwell
VP of Finance / CFO
Company data provided by crunchbase