The candidate will be a member of the Lab Management Program and will be responsible for designing, implementing, and monitoring a claims processing product that remains in alignment with rapidly shifting commercial, Medicare, and Medicaid medical policy. This requires a working knowledge of procedure coding, diagnosis coding, claims data elements, and claims system capabilities. Major responsibilities include: Work with medical policy team to understand the policy goals and ensure appropriate associated coding and claims processing language; Perform analytics to model policy-based claims processing to ensure the expected outcomes in historical claims data; Coordinate claims configuration design, implementation, maintenance, customization, and documentation; Act as subject matter expert for claims disputes; Monitor claims product performance, including accurate processing, value metrics, trends, unusual billing patterns, and opportunities for enhancement; and Manage projects to continuously improve the claims processing product.
Minimum Experience Required
- Bachelor's degree or equivalent work experience.
- Registered Health Information Administrator (RHIA) certification preferred.
- Experience in healthcare is critical with at least 5 years’ experience.
- Knowledge of laboratory medicine, and particularly genomics, is useful but not required.
- Solid understanding of claims data and processing systems
- Demonstrated experience using medical coding systems and databases
- Analytical, problem-solving nature with ability to work with data and reporting tools to research, organize, and summarize findings (SQL, Excel, Access)
- Detail-oriented with the strong organizational skills required to track thousands of claims policies
- Self-motivated with ability to define projects, prioritizeresponsibilities in a fluid environment, and work with minimal instruction or supervision
- Excellent verbal and written communication skills as well as the ability to effectively interact with all levels of staff and management.
Career ID 2018-4639