"Alerted.org

Responsibilities:

Under the general supervisor of the Manager Accounts Receivable, the analyst is responsible for identifying, validating, submitting and reconciling all maternity submissions accurately and timely for all applicable lines of business.; Based on State specific methodology and timeframes- i.e. weekly, monthly; accurately submit maternity delivery data via Newborn/Maternity Tracking Tool for creation of 837P:

+ Accurately submit maternity delivery data via state web portals for individual maternity submissions; while also updating Newborn/Maternity Tracking Tool; keeping systems in unison.

+ Ability to retain multiple sets of maternity criteria, medical billing logic; and maternity mapping logic.

+ Responsible for Newborn//Maternity Tracking Tool; system updates of ICD-10, Diagnosis codes, CPT, DRG, and procedure codes; Modifiers, Part A codes and Revenue rate data.

+ Be fluent with existing and new 820, 835 and 837P companion guides, system notices and or maternity documentation, adherence to requirements; advise management on needed actions to comply with state requirements as they occur.

+ Prepare EDI 820 premium payment files, EDI 835 maternity payment files and Adhoc files for data mapping documents at a column level from source columns mapped to appropriate target columns.

+ Continuous enhancement recommendations of Newborn/ Maternity Tracking tool for all plans.

+ Actively participates in Q/A of Newborn/Maternity tracking tool user acceptance testing functions, such as test script development, testing and documentation of test results.

+ Develops and maintains a complete understanding of all data sources (including, but not limited to the Data Warehouse, the Facets System and the NBTT) available for reporting so that research and analysis can be completed on discrepancies.

+ Responsible for meeting all monthly/ quarterly deadlines and provides full support to other areas such as Accounting, EDI, Enrollment, Encounters, Healthcare Apps, Statutory and the Actuarial departments.

+ Generates and updates reports for monthly maternity reconciliation, aging reports, financial audits and all other required reporting; Analyzes completed reports to ensure there are no material differences that should be escalated to management for review.

+ Maintains and creates maternity databases, queries, joins, tables and forms; designs and creates SQL stored procedures, technical specifications and user-defined functions, writing functional and technical specification documents.

+ Participates in the completion of all designated annual goals for the Financial Services department.

+ Communicates with management/stakeholders to determine appropriate courses of action prior to enacting changes in reporting processes.

+ Prepare for onsite audits of all tasks requiring process explanation and accountability.

Education/Experience:

+ Bachelors’ degree required.

+ 1 to 3 years knowledge of medical billing ICD-10, CPT DRG; claims coding ;Revenue Code Mapping, Data Analysis, Data warehousing, translated 5010 EDI files, financial reporting and related financial analysis experience.

+ Basic understanding of Claims Processing / Clinical Coding and business practices.

+ Basic working knowledge of business computer programs, applications and systems, database structures and data files required.

+ 2 years experience in healthcare finance and/or financial reporting, preferred.

+ Strong communication (both written and verbal), analytical and problem solving skills.

+ Excellent organizational skills.

+ Ability to work on multiple tasks with competing priorities; demonstrates strong subject matter expertise in the states and business processes that they support.

+ Ability to work accurately and independently as well as comfortable interacting collaboratively with all levels of business; open mind to consider alternative ideas and next steps for remediation.

Other Skills:

+ Efficient in;Microsoft SQL Server, Oracle, My SQL, SQL Server Reporting Services.

+ Proficiency in Excel, Access, preferred.;

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.