Business Configuration Analyst II

Company: CHRISTUS Health
Location: Irving
Posted on: March 18, 2023

Job Description:

Description
Summary:

The Business Configuration Analyst II will work in conjunction with Auditing, Member Services, Complaints and Grievances, Provider Data, Utilization Management, Claims and other operational departments. The position will be responsible for gathering comprehensive business requirements and translating them into configuration design and implementation. A thorough understanding of healthcare systems, data collection, analysis, strong organizational and record keeping skills are required.

Benefit research, design, configuration, testing and implementation for multiple product lines including Medicare, Commercial, Exchange and Tricare.
Attend management meetings in place of Configuration Management as needed
Research and resolution of defects related to UB04 and HCFA claims
Review, validate and load all codes for claims adjudication (ICD10, CPT9, HCPCS, Modifiers, HIPPS, etc.)
Maintain accuracy of clinical editing software (ex. Claim Check)
Fall out management for external pharmacy claims data via claims batch load.
Demonstrate the ability to locate, research, comprehend, and appropriately apply 3rd party payer rules and regulations; analyze and resolve complex coding related claim denials in a manner that ensure accurate and optimal reimbursement
Demonstrate clear and concise oral and written communication skills
Demonstrate strong decision making and problem solving skills; personal initiative to keep abreast of new developments in coding updates, technology, research, regulatory data; detail oriented and ability to meet deadlines
Ability to adjust successfully to changing priorities and work load volume
Audit and confirm the coding of diagnoses and procedures relevant to resolve the billing/coding edits
Review appropriate regulatory references to identify/substantiate diagnoses, procedures and modifiers that support services billed
Implement and adhere to change management requirements through compliance, legal, operation for reporting, approval signatures, and maintenance of changes
Works in conjunction with Business Analyst and the operational team for follow up, resolution, and trending of coding related denials and appeals
Maintains required productivity standards
Tracks opportunities for documentation, reimbursement and coding improvement
Provides information and feedback daily on coding related issues, edits, denials, reimbursement trends, and coding errors to Operational Management and Medical ManagementPerforms other duties as assigned
Ability to keep confidential information as such
Strong organizational skills and ability to manage multiple competing projects and deadlines
Ensures internal compliance with all Federal and State Regulations

Requirements:

Bachelor's degree in Business/Health Information Services, or equivalent configuration and/or coding experience.
Three years healthcare experience with equivalent configuration and/or coding experience; Managed Care experience preferred
Analytic ability to organize and prioritize work to meet deadlines
Proficient in Microsoft Office
Excellent written and verbal skills required
Good judgment, initiative and problem-solving abilities
Ability to handle and resolve complex issues with little assistance
Ability to perform multiple tasks simultaneously
Ability to communicate effectively
Thorough understanding of ICD9-CM, ICD10, DRG methodologies, CPT-4, Outpatient Code Editor and National Correct Coding Initiative policies
Knowledge of Claim Check system or equivalent clinical editing systems
Health Solutions Plus (HSP) experience preferred

Work Type:

Full Time

Keywords: CHRISTUS Health, Irving , Business Configuration Analyst II, Professions , Irving, Texas