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Configuration Analyst I- Claims

Company: PacificSource
Location: Springfield
Posted on: May 8, 2019

Job Description:

Responsibilities:Essential Responsibilities:

  • Process, troubleshoot, and resolve claims in the FBS Claims queue.
  • Designing new configuration to support business needs and functionality.
  • Accurately update, implement and test configuration changes including but not limited to patches, upgrades and new configuration.
  • Create and maintain service IDs and explanation codes.
  • Accurately maintain conversion tables, supplemental tables, and CES (clinical editing system).
  • Accurately document changes and communicate changes with the business.
  • Analyze business requirements, test plans, training materials and procedure documents.
  • Execute test plans and test case scenarios to ensure requirements are being met.
  • Participate in development of detail design and system walk through with respective teams to verify design & solution meet business and system requirements.
  • Assist and work with business areas for the review of all reported system defects.
  • Monitor, research, and resolve help desk tickets.
  • Responsible for quality assurance tasks.
  • Document the configuration of new plans as well as changes to existing plans.
  • Define, develop and document business requirements to ensure needs are captured and delivered.
  • Develop an understanding of Facets Batch Logs, review daily, and troubleshoot issues.Supporting Responsibilities:
  • Interact with business leaders and users, including external partners and customers as required. Maintain professional, service oriented relationships.
  • Judge severity of problems and the need to escalate to management or employ external services.
  • Demonstrate ability to organize and prioritize work.
  • Participate in special projects and committees as assigned.
  • Meet department and company performance and attendance expectations.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Perform other duties as assigned.QualificationsWork Experience:Minimum two years of relevant experience in health plan environments required. Minimum one year of general Facets experience required. Minimum 1 year experience working with benefit administration required. Proficient level work in Excel and Word. Access and/or SQL experience preferred. Must have knowledge of CPT, ICD-10, HCPCs and Revenue Codes. Strong analytical skills and problem solving skills. Excellent communication skills both verbal and written. Ability to participate in a team environment. Self-starter who requires minimal supervision.Education, Certificates, Licenses:BS/BA or equivalent combination of work experience and education.Knowledge:Extensive knowledge of industry standards and internal PacificSource, PacificSource Medicare, and/or PacificSource Administrators benefits, policy and processes. CompetenciesOur Values
  • Adaptability
  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Building Trust
  • Continuous Improvement
  • Contributing to Team Success
  • Planning and Organizing
  • Work Standards
    • We are committed to doing the right thing.
    • We are one team working toward a common goal.
    • We are each responsible for our customers experience.
    • We practice open communication at all levels of the company to foster individual, team and company growth.
    • We actively participate in efforts to improve our communities-internal and external.
    • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.Environment:Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Keywords: PacificSource, Springfield , Configuration Analyst I- Claims, Professions , Springfield, Oregon

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