Xcelys Benefit Configuration Analyst

posted on August 23, 2018

Job Description

Location: Tampa, FL

Type: Permanent

Job Description:

  • Collects and analyzes data to evaluate operational obstacles which include revenue and compliance issues and makes recommendations to resolve issues in a timely matter.
  • Uses the medical classification system to design the benefit packages with proper ICD-9, CPT-4, HCPCS for configuration into the Peradigm System.
  • Disseminates benefit determinations to key stakeholders administering benefits (health services, configurations, etc.) throughout the organization.
  • Serves as an integral role in the testing, analysis, and benefit configuration of new and existing plans.

Essential Functions:

  • Reviews, analyzes and translates diagnostic procedural phrases into coded form.
  • Updates and maintains adjudication system with defined code sets in logical order.
  • Coordinates with internal operations departments to ensure data accuracy.
  • Produces reports from the Peradigm System to analyze necessary modifications to codes sets, BRULES and MEDEFs.
  • Creates testing scripts for new and existing plans.
  • Assists in the on-going evaluation of the benefit configurations within the Peradigm System for new and existing benefit plans.
  • Documents the configuration of new plans as well as changes in existing plans.
  • Provides feedback to stakeholders regarding feasibility and requirements for enhancements to benefit configuration.
  • Provides research assistance for the resolutions of benefit issues.
  • Serves as a liaison of benefit configuration to external departments.
  • Collects and analyzes data to evaluate operational difficulties and makes recommendations to solve problems.
  • Performs special projects as needed.

Education:

  • Required An Associate’s Degree in CIS, BIS, or coding
  • Required or equivalent work experience

Experience:

  • Required 2 years of experience in medical coding and configuration

Skills:

  • Intermediate Other Applies coding knowledge to ascertain codes sets for each service
  • Intermediate Other Ability to break procedures down at a granular level and organize data in a logical manner
  • Intermediate Other Ability to conduct Internet research to update code sets

Licenses and Certifications:

  • Preferred
  • Preferred RMC certification

Technical Skills:

  • Required Intermediate Peradigm (Diamond)
  • Preferred Intermediate Microsoft Access
  • Preferred Intermediate SQL Server System
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Outlook
  • Preferred Intermediate Other Knowledge of organization of data within medical adjudication systems