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Inovalon · 2 days ago

Benefits Analyst (Claims Focused Analyst)

Bowie, MD

Full-time

Onsite

Entry, Mid Level

$56K/yr - $75K/yr

2+ years exp

Inovalon is a technology and data-driven company focused on transforming the healthcare ecosystem. The Benefits Analyst will provide in-depth analysis and create business rules for modifying medical claims, requiring strong knowledge of medical billing and coding.

AnalyticsHealth CareInformation Technology

No H1B

U.S. Citizen Only

Responsibilities

Take ownership of triaging incoming internal and external customer requests for medical claims processing changes needed

Prioritize requests based on operational needs and escalate issues to quick resolution when needed

Implement technical business rules for processing medical claims; including building logic statements based on specific medical insurance claims fields to modify and or change; test with medical claims and implement to live systems

Take a collaborative role with the application support team to triage production problems involving claims processing, perform defect analysis and provide fixes in business logic to be implemented by software teams in a timely fashion, particularly with high priority items

Work collaboratively with other Inovalon departments to ensure fit for purpose solutions are delivered

Liaise with Technology and Engineering teams to resolve application issues and enhancement requests to internal tools used by the team to expand capabilities

Ensure compliance to Company procedures when making changes and implementing new business rules

Ensure ongoing regularly scheduled updates required for compliance are executed timely

Responsible for accessing payer websites and compliance standards research (i.e. UB Editor, payer Companion Guides)

Review claim level and file level failures or errors ongoing to find and implement new rules as needed to ensure our first pass claim acceptance rate hits our internal goals

Update documentation, SOPs, and training documentation as needed

Maintain a follow up schedule for unresolved issues

Respond to support requests through phone calls, and emails

Assist operations with process improvement and finding solutions to business problems

Maintain compliance with Inovalon’s policies, procedures and mission statement

Adhere to all confidentiality and HIPAA requirements as outlined within Inovalon’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position

Fulfill those responsibilities and/or duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the Company

Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function

Qualification

Medical BillingClaims ProcessingLogic Rules BuildingMedicare/Medicaid KnowledgeTicketing System ExperienceAnalytical SkillsClient CommunicationMulti-taskingSaaS ExperienceProblem Solving