Claims Project Associate (Hybrid - Troy, MI) - Health Alliance Plan
🔍 Troy, Michigan
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.
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers.
Benefits
The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health 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.