What are the responsibilities and job description for the Healthcare - Business Systems Analyst II (66848) position at Professional Management Enterprises?
Business Systems Analyst II to be responsible for the accurate and timely maintenance of the Benefit Matrix tables in EZ-Cap for all databases. This position is fully remote. The work scheduled is Monday - Friday, 8 : 00am to 5 : 00pm EST.
Duties and Responsibilities :
Responsible for maintaining the Benefit matrix tables in EZ-cap, including but not limited to : Division of monetary responsibility, provider, payment rate, vendor, etc.
Update all tables as required by changes in the contracts or benefits.
Configure benefit categories and benefit adjudication rules.
Interpret changes to maintain and implement in EZ-cap database.
Import, process and export health plan benefits data.
Work closely with Claims, UM and Contracting departments to ensure an accurate system set up to the member's benefits and financial responsibility liability.
Ability to improve and automate the processes to expedite the system updates and ensures quality and data integrity.
Remain abreast of industry and health plan benefit changes to support managed care operations.
Review audit results monthly to ensure accurate benefit configuration.
Review provider appeals and correct the EZ-cap when necessary.
Education / Experience
Must have three years of claims processing and or auditing experience.
Internal / external audit experience is preferred
Proficient in medical terminology, CPT, ICD9, Revenue codes, HCPCS codes
Experience with EZ-CAP system claims module.
Required Education : Associate's or Bachelor's
