What are the responsibilities and job description for the Healthcare Services Analyst II position at HMSA?
Research and respond to low to medium complexity internal and external inquires.
- Is proficient at utilizing a variety of resources including but not limited to on-line information files and databases, Medicare / other plan guidelines, plan certificates, provider contracts.
- Make recommendations and decisions independently.
- Benefit and policy analysis & implementation :
- Initiate, develop, coordinate and implement cost / benefit analysis of claims processing.
- Extract and analyze data using SQL, MicroStrategy and / or other tools as available.
- Develop documentation, including cost / benefit and business impact analysis and recommendations to implement and / or improve claims processing.
- Update and create CES pend resolutions.
- Drive implementation of changes through writing of Work Intake Form, participation in multi-department meetings, contribution and review of requirements, validation of test cases, and post-implementation monitoring.
- Focus on low to medium complexity project implementations.
- New Code Implementation :
- Prepare and submit files for review and configuration implementation.
- Review new codes in assigned categories, work with Medical Management and Configuration to ensure appropriate claims processing / editing based on new code review.
- Post-implementation trends and workflow improvements :
- Identification and resolution of issues and trends as a result of researching and responding to implementation requests, problem reports, and inquiries.
- Develop clear, concise documentation complex business scenarios. This documentation will be used to develop policy / project systems and workflow requirements.
- Software implementation :
- Participate in the development of user requirements, test scenarios, and test validation activities.
- Continuing Education :
- Other duties as assigned
Assess business impact of new benefits, changes in medical or reimbursement policies / guidelines and tactics assigned in strategic planning.
Act as lead in loading of new codes by following existing documented process and timeline for downloading, processing and importing new codes (CPT, HCPC, ICD-10, etc.).
Support audits of implemented policies and completed projects. Identify and investigate areas involving cost increases, uncontrolled payments and / or inequitable payments.
Participate in the unit's efforts to implement new projects, software or software modifications.
Attends and successfully completes HMSA and Continuing Education training classes as assigned.
