Benefits Configuration Analyst

About the role

Come join our Peak Health team at WVU Medicine as a Benefit Configuration Analyst contributing to the foundation for an innovative, new health plan. This role will report to the Benefits Configuration Leadership, playing a unique and important role in our mission to change healthcare for the better.

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.

Qualifications

• Minimum Qualifications:
  • 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.
  • OR High School Diploma or equivalent AND Three (3) years of experience in health insurance, medical coding, claims processing or related field.
• Preferred Qualifications:
  • Bachelor’s degree in health information, healthcare, or related field.
  • Experience 6 years’ experience in health insurance and benefit design.