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AmeriHealth Caritas · 1 day ago

Maternity Revenue Analyst

Newtown Square, PA

Full-time

Hybrid

Entry, Mid Level

1+ years exp

AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience in health care solutions. The Maternity Revenue Analyst is responsible for identifying, validating, submitting, and reconciling all maternity submissions accurately and timely for all applicable lines of business, while also maintaining the Newborn/Maternity Tracking Tool and ensuring compliance with state requirements.

Health CareInformation Technology

H1B Sponsor Likely

Responsibilities

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

Qualification

ICD-10 codingCPT codingSQL ServerData AnalysisFinancial ReportingCommunication skillsOrganizational skillsProblem solvingTeam collaboration

Required

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

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

Efficient in Microsoft SQL Server, Oracle, My SQL, SQL Server Reporting Services

Preferred

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

Proficiency in Excel, Access, preferred

Benefits

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.

Company

AmeriHealth Caritas

Glassdoor3.4

AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.

Founded in 1982

Philadelphia, Pennsylvania, USA

10001+ employees

http://www.amerihealthcaritas.com

H1B Sponsorship

AmeriHealth Caritas has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (18)

2024 (17)

2023 (12)

2022 (14)

2021 (4)

2020 (11)