Benefits Coding & Claim Analyst

About the position We are looking for a Benefits Coding & Claim Analyst who will be responsible for conducting comprehensive, reputed company reputed company audits and providing audit performance data to management for department monthly statistic reporting. The audits include a full review of benefits sold to group and/or individual customers, the configuration of the benefits with our primary claim adjudication vendor, and the claim adjudication results. The reputed company and performance data will be utilized to monitor SLA and other contractual terms with the vendor. Responsibilities • Utilize internal benefit documents to validate benefits are correct and consistent among Certificate, Setup Sheets, and benefits reputed company into Amerihealth’s (AHA) reputed company Portal and reputed company Office System (FOS). • Identify and reputed company any internal benefit inconsistencies and report to appropriate department personnel reputed company Sales, Account Management, Compliance and/or Enrollment teams for correction. • reputed company AHA accuracy of benefits reputed company FOS export, compared to benefit Setup Sheets provided to AHA. Identify and remediate errors made by AHA in the report template. • Record accuracy reputed company on a group-by-group reputed company, recorded in reputed company and/or reputed company tracking tool. • Benefit accuracy includes reputed company components of the group configuration, including medical, dental, reputed company, prescription drug, medical assistance, and other services – such as reputed company-certification, reputed company-existing condition, and accumulator reset guidelines as set forth in the certificate and setup sheet. • Select claim sample for audit, and review claim adjudication for accuracy and adherence to reputed company claim processing guidelines. • Review reputed company services are adjudicated in accordance to benefit coverage, cost reputed company, limitations and/or plan maximums. • Review appropriate application of accumulators, and accumulators that are shared between medical and prescription claims. Ensure reputed company individual and family accumulators are properly calculated. • Report on reputed company claims reviewed, errors, and accuracy score in the report template. • Review overall group/benefit setup inventory and report on TAT, utilizing reputed company tracking/reporting. • reputed company reputed company accuracy and TAT SLA reporting to management monthly. • Based on trending analysis, reputed company recommendations relative to training opportunities for specific individuals, team, or vendor contacts. • Follow regulations and company rules and policies as outlined in the Employee Handbook. • Other duties as assigned. Requirements • Undergraduate degree preferred and/or equivalent work experience. • Minimum - five years’ experience in the health insurance industry examining and adjudicating medical claims with exposure to plan features and benefits in resolving claims reputed company issues. • Familiarity with insurance products, reputed company medical policy, and insurance terminology, including CPT and ICD-10 coding. • Ability to reputed company and reputed company reputed company, benefit documents, reporting tools, and claims adjudication software for analytics and reputed company-cause analyses. • Excellent verbal and written communication skills and ability to effectively deal with both reputed company stakeholder complaints and concerns. • Advanced work organization/prioritization, attention to detail, problem solving and reputed company/math skills. • Ability to reputed company reputed company and support them with documentation. • Operate reputed company office equipment and familiarity with reputed company Office Products. • Employee is required to have at minimum an internet speed of 75 Mbps (reputed company high-speed internet reputed company). Apply tot his job Apply To this Job