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Claims Systems Analyst in Latham, NY at Beacon Health Options

Date Posted: 11/30/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic Claims Encounters Systems Analyst to join our team in Latham, NY! The Business Systems Analyst is responsible for interfacing with the Encounters Exception Unit staff and leadership, clients, and IT teams to analyze trends in encounters data, conduct root cause analysis, recommend systems or operational solutions, document standard operating procedures (SOPs), provide training to encounter analysts, monitor claims recoupment projects, and provide general oversight over any systems testing.

Position Responsibilities:

  • Conduct analysis on encounter errors, exceptions and rejections.  Determine root cause of errors and recommend system or operational solutions.
  • Document change requests, submit change request tickets and monitor their progress.  Escalate delays or issues, as appropriate.
  • Monitor claim recoupment projects and periodically report progress.  Escalate delays or issues, as appropriate.
  • Participate in lead role to document operational processes and procedures in workflows and formal standard operating procedures (SOPs).  Update SOPs and workflows, as needed.
  • Conduct onboarding and training of new encounter analysts.
  • Coordinate with the Encounters Analysts IT, and other operational departments to conduct User Acceptance Testing (UAT) on new system features, requested changes and new client implementations.  Document and report on testing results.
  • Analyze large amounts of claims data in Microsoft excel to formulate and report on high level trends, relevant issues, and key findings.
  • Interface with clients, as required, at on-site meetings and telephonically to clearly present data analysis and solutions.
  • Devises or modifies procedures to solve complex problems surrounding encounters results.  Under general direction, formulates and defines objectives through research and fact-finding combined with a good understanding of business systems and industry requirements.
  • Serves as the primary liaison between Encounters Department and selected Clients on the topic of encounter submissions.
  • May require occasional, short term travel to Beacon engagement center and/or client site

Position Requirements:

  • Education:  High School diploma or GED equivalent required, Bachelor’s Degree in Computer Science, Management Information Systems or related discipline preferred
  • Relevant Work Experience: 2 years’ experience in a claims role accompanied with a minimum of 5years’ experience in an analysis role required
  • Knowledge, Skills, & Abilities:
    • Health insurance/Medicaid industry knowledge strongly preferred
    • Detailed understanding of claims and encounter processing required
    • Understanding of claims extract and response file requirements required
    • Detailed understanding of data analysis and file structures
    • Advanced Excel skills required.  Access ability desired
    • AS400 knowledge desired
    • Strong analytical and problem-solving skills required
    • Strong written and verbal communication skills required

To Apply:

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

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