Benefit - Data Quality Analyst - Terms & Conditions/Eligibility
Primary duties entail entry, analysis, documentation, and quality pertaining to the entry/inload of SynerMed Benefits & Enrollment. Responsible for ensuring optimal quality of this data, adherence to quality standards and related policy/procedure, ensuring on-going compliance with same, Quality Audit/Approval of Benefit entry, management reporting, assessment/recommendations and implementation of process improvements, project management, ongoing research of industry trends/updates and their application to SynerMed clients. QC inload files ensure completed by 20th of each month, run report to review an increase or decrease of enrollment by IPA, and Health Plan. Assist Provider Relations with any issue pertaining to doctor's office. Other duties include provider and other data entry into EZ-CAP, and report development using various PC- or network-based software applications used for the position. Ensures accuracy of all data entered taking time where needed to verify the data is entered correctly, and timely. Knowledge of Excel/Access is an important part of this position.
• Must be accurate in all work and familiar with all contracted Health Plans within IPAs/Hospitals to ensure proper entry into EZ-CAP.
• Audits Benefits to ensure proper copay assignment based on Hplan-option.
• Reviews newly entered contracted providers to ensure proper fee set assignment.
• Monitor SHARE and update DOFR or Benefits as needed.
• Respond to all SharePoint Reimbursement inquiries in a timely manner 48 to 72 hours.
• Adds Medicare benefits monthly and yearly. Ensure all copay information enter with accuracy, and timely.
• Monthly reports to monitor enrollment increase or decrease. QC inloads to ensure all files completed by 20th of each month.
• Communicates issues, project details, raises questions and clarifies priorities with Supervisor/Manager to ensure effective task completion.
• Interfaces effectively with providers and other customers in research and other data entry and improvement projects.
• Follows interdepartmental policies and procedures as set by the supervisor/manager.
EXPERIENCE, TRAINING, SKILLS:
• Able to communicate with others clearly, tactfully and professionally.
• Must have at least 7 years of experience with claims.
• Must have at least 3 years of experience as an auditor and/or supervisor
• Must be familiar with correct coding edits, bundling and unbundling, and other issues related to fraud and abuse.
• Must be detail oriented.
• Must be able to follow directions and perform independently according to departmental standards when no directions are given.
• Strong desire to learn.
• Must speak, read and write English.
SynerMed is a market-leading healthcare organization specializing in government-sponsored programs headquartered in Monterey Park, California. SynerMed is dedicated to innovating healthcare through an integrated system of tools, purpose-built web platforms, and professional services that connect physicians, members, hospitals and health plans. SynerMed's mission is to transform the healthcare system by rewarding high-quality and cost-effective care. For more information about SynerMed, visit www.synermed.com and www.synermedconnect.com.
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Monterey Park, CA
Sat, 6 May 2017 12:52:21 PDT