Claims Project Associate (Hybrid - Troy, MI) - Health Alliance Plan
GENERAL SUMMARY:
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.
PRINCIPLE DUTIES AND 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.
EDUCATION/EXPERIENCE REQUIRED:
- Associate’s Degree in Business Administration, Health Administration, Finance, or related field, required. Relevant experience may be considered in lieu of
academic requirements. Related experience is defined as 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.
CERTIFICATIONS/LICENSURES REQUIRED:
- Coding credential or obtain within one year from date of hire, required.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, Â Â Â Â Â companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
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Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s Â
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Â Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. Â My Choice Rewards is a program as diverse as the people it serves. Â There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. Â As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services. Employee's classified as contingent status are not eligible for benefits
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.