Research and Analysis:
- Research and respond to low complexity internal and external inquires.
- Use a variety of resources including, but not limited to on-line information files and databases, peer guidance, interviews with internal departments including clinical consultants, other Blue Cross/Blue Shield Plans and vendors.
Benefit and policy analysis & implementation:
- Learns to assess business impact of new benefits, changes in medical or reimbursement policies/guidelines and tactics assigned in strategic planning.
- Learns to conduct 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 complexity project implementations and pend resolution updates.
New Code Implementation:
- With the guidance of the Healthcare service analyst II, learns how to load new codes, downloading, processing and importing new codes (CPT, HCPC, ICD-10, etc.).
- 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:
- Learn how to support audits of implemented policies and completed projects.
- Identify and investigate areas involving cost increases, uncontrolled payments and/or inequitable payments.
- 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.
Continuing Education:
- Attends and successfully completes HMSA and Continuing Education training classes as assigned.
Other duties as assigned.

Bachelor's degree or equivalent combination of education and work experience.
One year related work experience.
Effective verbal, written communication skills
Excellent organizational and analytical skills
Good working knowledge of Microsoft Office applications.

Healthcare Services Analyst I

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