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Community Care is hiring a Claims Support -System Production Support Analyst II. This rewarding opportunity is perfect for someone who enjoys team collaboration, being part of a mission driven organization and who shares our mission to help elderly individuals and adults with physical and intellectual disabilities continue to live as independently as possible in the community.
Under the supervision of the Payor Architect Analyst, is responsible for maintaining the day-to-day operational functions of the Payor systems. Monitors Claims System and other related systems utilization, including reporting to ensure consistent adherence to documentation protocols and quality standards. Responsible for system and reporting implementation, development, upgrades and modifications of the Claims System and other related systems, in collaboration with the Payor business units and the Information Technology (IT) Staff.
Claims Support Job Responsibilities
After Hours Response
Responsible for timely responses to IT events and alerts that occur after hours and that correspond with internal and external SLAs or support commitments. These events occasionally correspond with weekend and evening work.
Application Management
Sets up and maintains application and interface functionality and security in accordance with business requirements as defined by business units or corporate policy.
Works with team members to predict trends for application support and data growth. Perform QA testing to ensure software meets all business requirements.
Data Collection & Recording
Assists in the accurate collection, recording and management of data for various reports and databases. This includes but is not limited to required regulatory and business reporting through data gathering, analysis, presentation and process documentation. Identifies and facilitates ongoing data analysis and measures to ensure successful implementation of change and to identify additional areas for improvement. Determines and documents root cause and escalates incidents as necessary.
Product and Service Research
Maintains current industry knowledge on trends and best practices and is able to apply such knowledge and practices to daily efforts. Is familiar or becomes familiar with healthcare IT initiatives and requirements outlined in current guidelines such as HIPAA and HITECH and keeps abreast of developments in IT healthcare requirements and goals. Knowledge of X12 837 and 278 standards.
Encounter Reporting
Works closely with development staff and internal stake holders to design and develop Medicare encounter reporting applications. Confirms all Medicare encounters are delivered successfully.
Ensures all Medicare and Medicaid transaction rejections are reviewed and resubmitted once corrected.
Participates regularly in CMS and DHS encounter reporting calls and workshops in order to guide Community Care through changing technical requirements.
Electronic Data Interchanges
Loads EDI transactions to claims system and monitors to ensure all transactions are accounted and addresses technical problems when they arise.
Maintains documentation of results and escalates issues as necessary.
Works closely with development staff and internal stake holders to design and develop EDI applications that increase production efficiencies or to meet changing business requirements.
Design
Elicits and documents business and system requirements for assigned projects using best practices. Transform requirements for each feature into an initial system design by considering various approaches to (categories of) modeling and constructing goal driven use cases.
Provide guidance on the technical environment for the system. Documentation should focus on how to deliver the required functionality of each feature and in turn the entire system. Uses knowledge of X12 standards to create solutions to meet business requirements and to problem solve with internal and external stake holders.
Build and complete test cases based on initial use cases and use case scenarios.
Demonstrate through system, security and user acceptance testing that the developed/implemented system meets all the requirements (initial requirements gathering and subsequent iterations), functions according to design parameters and satisfies all business, technical and management stakeholders.
Follows Community Care's guidelines for testing, quality assurance and security. Ensures appropriate business process and technical documentation are created as part of the project process.
Application/System Knowledge & Documentation
Develops and maintain working knowledge of how applications are used by the departments and/or end-users for both purchased as well as in-house developed applications.
Creates and maintains detailed and accurate application and system documentation to reflect current system state including monthly trend analysis, EDI interface requirements, payer specific business logic and Medicare encounter reporting.
Create user stories in the product backlog to support the development of EDI applications.
Operations & Maintenance
Provide post implementation support for in house developed applications/ systems and reporting structures. This includes managing changes to the system, monitoring of system performance and management of certain security activities such as contingency planning and audit preparation/response. Extending end user support through training and documentation. Identify defects, enhancements, patches and updates.
Risk Analysis
Assist the Payor Architect Analyst to performs risk analysis for functional areas to identify points of vulnerabilities and recommend risk avoidance and reduction strategies.
Performs other job-related duties as assigned.
Claims Support Experience
Required - Minimum of two years of experience working with supporting a claims system, EDI transaction support or Business Analytics.
Preferred - Thorough knowledge of claims systems and HIPAA transaction sets. Proficiency in Microsoft Office applications including Word and Excel.
Extensive practical knowledge in importing data for use in report software, spreadsheets, graphs and flow charts. Good working knowledge of both claims and computer terminology.
Knowledge of HIPAA Privacy and Security Rules. Knowledge of ANSI X12 standards used in the health care industry.
Knowledge of how databases work and ability to write basic SQL statements.
Basic knowledge of UNIX and using a command line interface. Basic knowledge of services covered by Medicare and Medicaid.
Claims Support Education Required
Required - Associates Degree in Information Systems, Information Management or Health Information Systems
Preferred - Information Systems or closely related field preferred
Additional Requirements
Understanding of claims and workflow systems from a processing perspective Practical knowledge of data analysis tools such as Microsoft Access and Excel
Working knowledge of medical terminology Knowledge of SFTP tools such as FileZilla Knowledge of AIX command line batch processing or other batch processing functions
Working knowledge of ANSI X12 medical electronics data interchanges (EDI) such 837 claims, 278 services review, and 835 electronic remittance transaction sets
Community Care is a nonprofit organization with over 40 years of experience helping adults with long-term care needs live as independently as possible. Our Medicare/Medicaid long-term care programs serve the needs of older adults and adults with disabilities. We coordinate and deliver a full range of supportive services that help them live safely, confidently and with dignity.
More than 10,000 Wisconsinites trust in us to provide the quality support needed to help them reach their potential in health, happiness and independence. We are Wisconsin-based and have local offices supporting each of the 14 counties we serve.
Compensation and Benefits:
Our employees make a real difference in people's lives every day. To show appreciation, we're dedicated to offering competitive pay and a comprehensive benefits package to our staff that addresses their mental, physical and financial health and well-being.
If interested in joining Community Care, please apply and our recruitment team will reach out promptly.
Equal Opportunity Employer
- Job Family Claims
- Halogen Template Staff Business Support
- Pay Type Salary
- Bishops Woods - Waukesha County, 205 Bishops Way, Brookfield, Wisconsin, United States of America