[Outsource:59410] Urgent Facets Technical Analyst – 4 Positions - Claims, Financials, Membership, Billing, MN, Rate: $50/hr

Facets Technical Analyst – 4 Positions - Claims, Financials, Membership, Billing

(2 onsite and 2 remote)

 

Location: Minneapolis, MN

Duration: 6 - 9 months

Interview: Phone Hire

Client: Confidential

 

Knowledge of Billing, Claims, Membership and Financials is expected with Facets technical skills

 

Responsibilities:
1. Supports the provider appeal process including assessment of appropriate coding, medical record review, and CCI bundling edits.
2. Supports claims, customer service and appeal operations staff by providing accurate and consistent responses to claims billing and reimbursement issues and coding questions.
3. Collects and analyzes data to evaluate the effectiveness of medical policy implementation and support business decisions regarding utilization management activities, including data gathered across the organization.
4. Supports medical policy development and implementation by identifying and updating appropriate procedure and diagnosis codes for company medical policies that reflects medical necessity, experimental/investigational or other code categories.
5. Identifies and recommends action steps to management and business partners based on data analysis (e.g. code configuration issues annual utilization review analysis)
6. Develops and uses data gathering tools to documents and analyzes patterns of code payments and denials, medical policy changes and coding changes.
7. Acts as a resource to company associates supporting the process of evaluation, analysis and code maintenance for utilization review activities.
8. Provides subject matter expertise to a variety of internal committees as assigned.
9. Completes special projects and other duties as assigned.

 

Qualifications

·         5+ years of gathering and documenting project requirements/specifications and experience with the System Development Life Cycle.

·         5+ years of FACETS technical operations skills and health insurance industry experience are critical.

·         Understanding of the FACETS batch system and capabilities  (i.e. order of run, errors, restarts etc).

·         Experience with key word files and their structure.

·         Ability to understand the FACETS underlying RDBM system (ORACLE, Sybase, MS SQL).

·         Ability to understand various FACETS utilities for performance of specific tasks (e.g. Medicare enrollment).

·         Ability to work with FACETS core tables and update in batch mode or on a specialty basis.

·         Experience working with ancillary systems and products and understanding of how they work with the main FACETS instance (i.e. NetworX etc).

·         Knowledge of how extensions can be built and used to augment a core FACETS instance… (i.e. how data is passed into and out of the main instance for use by extensions).

 

Knowledge of Billing, Claims, Membership and Financials is expected with Facets technical skills.

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