Benefits Coding Anaylst

Job ID: J117343
Company: United Concordia Companies Inc
Location: Harrisburg, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at:

Share:

Description

GENERAL PURPOSE:  

Analyze, design, and code new clients/groups or products, maintenance of existing groups/products, corporate projects, strategic initiatives, benefit enhancements, and application of medical policy.  Analyze data to determine business problem, trends, or opportunities for process improvements. Provide root cause analysis and corrective action plans. Provide production support via defect fixes, CRs or any other related issue.   Provide subject matter expertise to various teams.

Responsible for verification that the delivered application code meets the customer needs based on the specifications, ensuring minimal defects in both UAT and production.  Accountable for identification, documentation, and escalation of risks, defects and issues throughout the project lifecycle.   Responsible for assisting in the resolution of risks, defects and issues.  For smaller projects or initiatives may be accountable for project schedule and resource allocation up to and including matrix staff.  May have accountability to provide project status back to the appropriate Management group or customer, release co-coordinator and/or various PMO groups.

ESSENTIAL RESPONSIBILITIES:

1. Work with customers, application developers, architects, project management and team members to understand business requirements that drive the analysis and design of quality business solutions.  Communicate effectively to explain technical benefits, application of medical policy, and claims processing capabilities and functionality.

2. Work independently or a team member, to develop benefits and medical policy coding applications/solutions and perform project activity. Provide required business and/or subject matter expertise for both project and production related activities. May also participate as a subject matter expert in strategy development for new strategic programs.

3. Research claims processing problems, perform initial problem identification and resolution activities and debug benefits and medical policy program coding.   Document the results of problem analysis/research and prepare the specifications necessary to identify impacted claims.

4. Provide assistance on development of project deliverables – e.g. vision documents, business requirements, use cases, supplemental specifications, user design, testing plan, testing schedule, testing scenarios, testing outcomes, approvals, and training materials.

5. Manage job tasks and project requirements so that work is completed on time, in scope, within budget, and with minimal defects. 

6. Perform root cause analysis and coding implementation to include:

  • Testing
  • Data clean-up
  • Business procedures implementation (suspense correction)
  • Business/Technical sign-off on CRs and projects

7. Follow coding structured protocols and maintain coding documentation.  Perform system testing for coding group and production applications.   Assist in development of testing plan, scenarios, documentation and defect management to ensure minimal production defects are realized.  Complete analysis of the results tying back to customer impacts.  Interface closely with the business and technical staff during all phases of a project, including unit and system testing, integration and UAT testing culminating with implementation checkout and post implementation support

8. Other duties as assigned or requested.

QUALIFICATIONS:

Education, Experience, Licenses/Certifications

Minimum

  • High School Diploma
  • 3-5 years of relevant, progressive experience in the area of specialization. Grandfathered experience requirements effective August 2016.

Preferred

  • Bachelors Degree in MIS, Computer Science, Business

SCOPE OF RESPONSIBILITY  

Does this role supervise/manage other employees?         

No 

      

WORK ENVIRONMENT

Is Travel Required?

No  

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

Share:

Interested in working at the Highmark Health enterprise?
Take the first step by joining our Talent Network today!

Join Our Talent Network

Similar Jobs

Patient Access Coordinator I - Psychiatry - North Shore - Full Time

Pittsburgh, PA, United States
Administrative Services

Senior Healthcare Project Manager

Pittsburgh, PA, United States
Other

Internal Communications Analyst

Pittsburgh, PA, United States
Communications

Call Center Representative

Erie, PA, United States
Customer Service

Registered Nurse- Ortho

Monroeville, PA, United States
Nursing

Associate Business Analyst

Pittsburgh, PA, United States
Other

Medical Assistant Certified Sr. - Dermatology - Fox Chapel - Full Time

Pittsburgh, PA, United States
Patient Support

Decision Support Specialist

Pittsburgh, PA, United States
IS/IT

Histocompatibility Technologist

Pittsburgh, PA, United States
Laboratory

SR Accountant

Camp Hill, PA, United States
Finance

Medical Assistant Certified - Dermatology - Fox Chapel - Full Time

Pittsburgh, PA, United States
Patient Support

Medical Assistant Certified - Dermatology - Fox Chapel - Full Time

Pittsburgh, PA, United States
Patient Support

Care Connect Elite Call Center

Pittsburgh, PA, United States
Customer Service

Sr Architect

Camp Hill, PA, United States
IS/IT

Registered Nurse- Med/Surg

Jefferson Hills, PA, United States
Nursing

Project Manager - System Oncology - AGH

Pittsburgh, PA, United States
Other

OR Nurse

Pittsburgh, PA, United States
Nursing

Application Developer - Java

Pittsburgh, PA, United States
IS/IT

Director of Provider Contracting - Value Based

Pittsburgh, PA, United States
Procurement

SVP, Post-Acute

Pittsburgh, PA, United States
Clinical Services

Director Underwriting & Pricing- Managed Care

Home, MN, United States
Finance

Director Underwriting & Pricing- Managed Care

Home, PA, United States
Finance