Claims Project Associate (Hybrid - Troy, MI) - Health Alliance Plan

Hap (Hmong American Partnership) • Troy, MI

272d • Hybrid

About The Position

Under minimal supervision provide assistance to the Claims Project Analyst to support medical coding (ICD-9, ICD-10, HCPCS, CPT, DRG, and DSM) to a variety of internal departments. Serve as the secondary contact for ClaimsXten including providing medical coding expertise, quality assurance, education and training initiatives for the Claim Operations Division.

Requirements

• Associate's Degree in Business Administration, Health Administration, Finance, or related field, required.
• Four (4) years' experience in claim audits or medical record audits.
• Three (3) years of related experience in medical claim administration and medical coding, preferably with both a managed care and an indemnity environment, required.
• One (1) year project management/coordination and/or system implementation experience, required.

Nice To Haves

• Coding credential or obtain within one year from date of hire, required.

Responsibilities

• Provide project support under the direction of the Claims Project Analyst for the claims division on corporate initiatives.
• Identify, investigate, and resolve related system and data management errors that impact MA adjustment.
• Assist Claims Project Analyst with CSC/CMS audits and complaints.
• Assist Claims Project Analyst in guiding support analysts in performing routine assignments, ad-hoc projects, and meeting established deadlines relating to Medicare and ClaimsXten appeals.
• Assist Claims Project Analyst in participating in system and process development, including testing.
• Support the Claims Project Analyst in developing/executing processes to ensure medical codes used within Payer processes are identified, updated, approved, and implemented.
• Investigate and resolve workflow holds related to ClaimsXten editing and make code editing recommendations to the Claims Project Analyst.
• Manage the Clinical Code Editing Pega workbasket for cases related to ClaimsXten appeals.
• Execute ClaimsXten reports created in Cognos, resolve the claims until Xten automation is implemented.
• Participate in weekly ClaimsXten meetings, along with the Claims Project Analyst, to support updates and CRA implementation.
• Perform other related duties as assigned.

Benefits

• Competitive health plan options, including three consumer-driven health plans (CDHPs), a PPO plan, and an HMO plan.
• Dental and eye care coverage.
• Tuition assistance.
• Family forming benefits.
• Discounts to dozens of businesses.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Sporting Goods, Hobby, Musical Instrument, Book, and Miscellaneous Retailers
• Education Level: Associate degree