Top 587 Facets configuration Jobs

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Resolution Technologies —Keller, TX
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Northrop Grumman —Roy, UT
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Crusher Operator
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Crusher Operator
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8d

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Business Analyst, Claims (Onsite 3 Days/Week)

VNS Health -
Manhattan, NY

Apply Now

Job Details

Full-time
$66,300 - $79,800 a year

Benefits

Continuing education credits
Internal mobility program
Paid holidays
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Tuition reimbursement
Paid time off
Vision insurance
Opportunities for advancement
Life insurance
Referral program

Qualifications

Medicare
Managed care
Managed care organization experience
CMS
Regulatory compliance in claims processing
Visio
CMS regulatory compliance
Medicare regulations
Centers for Medicare & Medicaid Services (CMS) billing regulations
Medicaid regulations
Medicaid
Productivity software
Project stakeholder communication
Cross-functional communication
Stakeholder management

Full Job Description

The Business Analyst, Claims supports health plan claims operations by investigating complex claims issues, analyzing data, and driving process improvements. Working closely with Claims Operations and cross-functional teams, this role identifies root causes, supports system enhancements, and helps ensure claims are processed accurately, efficiently, and in compliance with regulatory requirements. We encourage candidates with experience in managed care claims, claims auditing, claims processing, or appeals & grievances to apply.

What We Provide

Referral bonus opportunities
Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
Employer-matched retirement saving funds
Personal and financial wellness programs
Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
Generous tuition reimbursement for qualifying degrees
Opportunities for professional growth and career advancement
Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities.

What You Will Do

Investigate complex claims issues and identify root causes.
Analyze paid, denied, and pended claims to ensure accurate adjudication.
Review provider disputes and resolve claims within established service level agreements.
Manage claims analysis projects ranging from individual claims to large claim populations.
Identify trends and recommend process improvements to improve claims accuracy and efficiency.
Collaborate with Claims Operations, Configuration, Eligibility, Credentialing, and other business partners to resolve claims issues.
Gather business requirements and support system enhancements and testing activities.
Audit processed claims and recommend corrective actions when needed.
Analyze claims data and prepare reports to support operational decision-making.
Perform financial impact analyses related to reimbursement and payment changes.
Manage workload to meet departmental goals and service level expectations.
Participate in cross-functional initiatives and special projects.

Qualifications

Education:

Bachelor's Degree in Business or related discipline or the equivalent work experience, required
Master's Degree in Business Administration, Public Administration or related field, preferred

Work Experience:

Two years' experience with claims in a healthcare setting required. Experience with managed care claims preferred.
A year of experience with a managed care organization on business transformation required
Two years' experience using FACETS, SQL scripts & queries, OBIEE, Power BI, Tableau & MicroStrategy reports & dashboards; project management & SDLC methodologies, with contracting and new business management across relational databases, using Oracle, SQL Server & DB2, managing stakeholder expectations and providing HIPAA-compliant guidance to business partners, vendors, and end-users, per industry standards for EDI protocols preferred
Strong command of Microsoft Office Tools (Word, Excel, Visio, and PowerPoint) required
Effective oral and written communication skills, consulting and analytical skills and ability to work with clients, IT management, staff, consultants and vendors required
Ability to function autonomously, and collaborate with most senior level leaders across the agency required
Demonstrated understanding of NYS, CMS and Medicare & Medicaid reimbursement guidelines. APG, APC, DRG required

Pay Range

USD $66,300.00 - USD $79,800.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.

Apply Now

Refine Your Search

facets configuration jobs

Business Analyst, Claims (Onsite 3 Days/Week)

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Sentinel Manager Software Engineering 2 - 18823*

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Crusher Operator

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I want to receive the latest job alert for facets configuration

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