Benefits Coding, NPS
Responsibilities: * Reads customer documentation, such as a *NAEG*, to clarify business coding requirements for benefit coding. 10%
* Builds coding grids for the benefit coder. 15%
* Builds unit test plans and schedules 15%
* Enters data into NPS table and GENO tables utilizing input from customer submitted CSR*s. 10%
* Enters coding into the NPS Benefit File utilizing input from customer submitted CSR*s or Benefit Analyst submitted instructions.10%
* Performs product validation activities including test planning, test development, issue/defect triage and test execution by performing a variety of tests on the NPS code to ensure claims process according to specifications or to determine cause of claim failure using EEC or Compuware tools 10%
* Communicates with Plan customers and team leaders to validate testing desired outcomes 5%
* Analyzes quality problems as related to customer assigned problem logs.15%
* Builds and Runs Test Claims from subscriber information on NPS, working those claims to ensure that they process through the system, and obtaining the results from the claim processes. 5%
* Builds Test membership in membership system in order to run test claims 5%
* Documents and distributes results to team lead through email.
* Verifies needs and impacts of test issues on users* and NASCO*s system environments
* Performs various reporting on quality analysis and trends
* Compares results with specifications and records test data
* Analyzes test results to determine cause of failure, applying knowledge of claims process and benefit terminology
Requirements: * MUST have experience with healthcare and benefits coding. Must have knowledge of benefit terminology as found in the certificates and riders of health insurance documents.
* MUST have knowledge of health insurance claim forms and claim form fields so that claims can be manipulated by working the appropriate field in order to adapt claims to different scenarios.
* MUST have experience with Benefit Coding in healthcare environment.
* MUST be able to work from home - this is a TELECOMMUTE ONLY position
* 1 year experience adding and processing health care claims or equivalent experience
* 1 year processing health care claims
Desired Job Competencies: * GEM system knowledge
* Knowledge of software quality assurance testing
* Experience adding and processing claims into the NASCO claim system
* At least 1 year processing claims on the NPS
Atlanta, GA 30328
Phone: (404) 601-3310