Configuration Analyst - Technical Claims Editing (Temporary)
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. CONFIGURATION ANALYST - TECHNICAL CLAIMS EDITING (TEMPORARY) Position DescriptionThis position is responsible to identify and analyze changes to CPT, CPCS, ICD-10-PCS, ICD-10-CM codes and proprietary laboratory codes and to facilitate the timely implementation of same across all business systems. Collaborate with staff to enhance operational effectiveness and efficiency by identifying opportunities for automation of existing manual claims processes. Research and resolution of complex clams and reimbursement issues. Accurately elicit, analyze, research and write business requirements and provide recommendations of claim edits for Commercial and Medicare lines of business. Collaborate with UCare and vendor to address upgrades and updates to Claims Editing System (CES) and any related hardware and/or software updates and upgrades. Collaborate with Project Managers to implement larger scale updates to software applications and complex claims editing.·Participate in activities related to the testing of core systems, database impacts and interfaces to meet the business requirements.·Serve as a Subject Matter Expert on CES, code editing and claims editing focusing on Commercial and Medicare lines of business. Identify and analyze coding changes as they relate to accurate claims processing. ·Collaborate with vendor and UCare resources to ensure successful implementations of edit rules and regulatory updates as it pertains to Commercial and Medicare lines of business. ·Identify, research and resolve inaccuracies and inconsistencies in the system as they impact claims payment and adjudication and other upstream and downstream transactions and processes. ·Conduct audits of system updates and edit configuration in production to confirm system function and CES editing matches requirements. ·Collaborate with key internal departments to manage and resolve complex claim issues, maximize operational effectiveness and support claim automation.·Other projects and duties as assigned.EducationHigh school or equivalent. Current and valid certification as a professional coder from an accredited institution.Required Experience
Three years of experience as a certified coder in a healthcare delivery setting, health insurance (payer) setting. Experience and knowledge of Commercial and Medicare lines of business. Experience with claims editing utilizing the CES application.Preferred ExperienceBachelor's degree or equivalent. Expertise in the implementation, support and troubleshooting of applications software. Experience with configuration of business rules in a healthcare claims processing application. Microsoft Word, Excel and PowerPoint skills. Optum Claims Editing Software (CES) - professional and facility. THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 9th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.