Healthcare Services Analyst I

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: Assess business impact of new benefits, changes in medical or reimbursement policies/guidelines and tactics assigned in strategic planning. 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.
• New Code Implementation: 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. Support audits of implemented policies and completed projects.
• Post-implementation trends and workflow improvements: Identify and investigate areas involving cost increases, uncontrolled payments and/or inequitable payments. Identify and resolve 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.

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.