- CPT Coding
- Supervising Experience
- Dental Insurance
- Health Insurance
To be fully engaged in providing No Harm / Quality, Customer Experience, and Stewardship by\: providing superior quality, competitive value and outstanding service by planning for and implementing new and upgraded versions to assigned systems. This includes developing, communicating, education, maintaining and supporting systems, processes and procedures required to support the needs of the HFHP Configuration Department. Has knowledge of operation work flows for the purpose of transactional troubleshooting. Proficiently applies knowledge to ensure quality assurance. Consistently demonstrates the ability to achieve and maintain established and acceptable levels of customer service and transactional accuracy and productivity. Acts as the Data Steward to HFHP I/S. In addition to HFHP I/S, this associate works closely with the other HFHP departments to assure that the applications are utilized appropriately by the departmental staff. Have the desire and ability to work in a fast-paced team environment. Using business knowledge (individual considered a subject matter expert in one AA Subsystem and/or application) to trouble shoot, coordinate the implementation of problem solutions and communication to departments. Participate on cross departmental teams representing the application functionality and to validate business requirements. Additional responsibilities include assisting with the coordination of user training, and managing small to medium assignments independently. The Associate will also work closely with IS System Analysts, resolving or escalating issues according to established practice. Have the desire and ability to work in a fast-paced team environment, while providing outstanding customer service to both internal and external customers. Primary Accountabilities Adheres to all regulatory and certification guidelines including HIPAA, state and Federal Guidelines, and others as communicated through management. Collaborates and communicates effectively with multiple departments. Demonstrates ability to effectively work as a team member. Performs routine and intermediate duties independently. Utilizes resources wisely when troubleshooting issues. Discusses or seeks approval on intermediate level Provide troubleshooting; process design, and supporting documentation for configuration projects, with supervision. Understand the “front end” of assigned applications inside and out, knowing how the users work within the application as it relates to their work flow. Keeps up with the latest releases of assigned applications and becomes the application expert. Share knowledge within the Operations department. Working with HFHP I/S Systems Analysts, assists in coordination for implementing system upgrades related to departmental needs. Develops and works with staff training programs as necessary to maintain end user knowledge and application skills equivalent with the latest system software release. Creates documentation and maintains on an annual basis. Manages small and medium sized projects with supervision, and works directly with the departmental staff acting as the main point of contact, super end user, and interfaces with HFHP me /S with regards to their assigned applications for the Operations department. Work with HFHP I/S as the Operations Department Data Steward. Works to resolve workflow issues and deliver applications in such a way that the systems meet the needs of assigned departments. Makes a minimum of 1 recommendation per year for system and process improvements that are implemented. Works with end users within the Operations Department to create reports, understanding the data structure of the assigned applications and coordinates efforts to maintain data integrity for those applications. Is considered the data system owner for supporting systems. Completes reports on a timely basis as agreed to with Management. Consistently seek ways to improve operational efficiencies through better use of system resources.
Bachelor’s Degree in health care, business administration or a related field; or a combined completion of college course work and a minimum of two years in a managed care or insurance environment with emphasis on system configuration, and/or information technology demonstrating ascending roles of responsibility will be considered. Willingness to learn System application configuration Advanced knowledge of medical benefits, medical and dental terminology, advanced knowledge of claim adjudication and benefit plan application for Point of Service, HMO, Medicare plans, PPO Off and On Market Place Advanced knowledge of provider reimbursement. Advanced knowledge of Medicare coverage/guidelines and Commercial HMO/Health Insurance contracts. Advanced knowledge of CPT, ICD-9, ICD-10, HCPCS coding systems and CMS Fee Schedules Experience in supervision, team building and problem-solving in a complex health care system