GENERAL SUMMARY
Responsible for entering and maintaining coding customizations, or provider and/or benefit rules of the system. Ensures data integrity within the system. Maintains policies and procedures relative to benefit plans, claims and pricing rules, and departmental goals.
ESSENTIAL RESPONSIBILITIES
- Works with claims personnel on a daily basis to ensure that the code auditing, benefits processing, and system functionality is maintained at the highest level and in compliance with medical policies and/or business rules.
- Investigates and confers with Coventry personnel when system inconsistencies occur. Offers solutions and makes changes if necessary.
- Maintains data dictionaries and/or pricing documentation as assigned. Tests and maintains system to ensure accuracy and compliance.
- Analyzes new rules and/or legislation for claims, benefit, or pricing applications. Recommends and makes changes as required.
- Develops and maintains policies and procedures relating to code auditing and benefits, claims and pricing rules.
- May load, test and maintain benefit plans or customizations. May load and test database upgrades to ensure the accurate transfer of data.
- May attend meetings when new products, new contracts, or new system enhancements are being initiated to offer system recommendations regarding benefits, claims and/or pricing procedures.
- Completes ad hoc reports as required.
- Responsible for independent project management as assigned.
- Performs other duties as required.
Qualifications:
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Cranberry Township, PA, US
Organization: 51700 - MHNet Claims Administration
Schedule: Full-time
Job Posting: 2013-01-28 00:00:00.0
Job ID: 1310252