Healthcare - Business Systems Analyst II (66848)

Business Systems Analyst II to be responsible for the accurate and timely maintenance of the Benefit Matrix tables in EZ-Cap for all databases. This position is fully remote. The work scheduled is Monday - Friday, 8:00am to 5:00pm EST.

Duties and Responsibilities:

• Responsible for maintaining the Benefit matrix tables in EZ-cap, including but not limited to: Division of monetary responsibility, provider, payment rate, vendor, etc.
  
• Update all tables as required by changes in the contracts or benefits.
  
• Configure benefit categories and benefit adjudication rules.
  
• Interpret changes to maintain and implement in EZ-cap database.
  
• Import, process and export health plan benefits data.
  
• Work closely with Claims, UM and Contracting departments to ensure an accurate system set up to the member's benefits and financial responsibility liability.
  
• Ability to improve and automate the processes to expedite the system updates and ensures quality and data integrity.
  
• Remain abreast of industry and health plan benefit changes to support managed care operations.
  
• Review audit results monthly to ensure accurate benefit configuration.
  
• Review provider appeals and correct the EZ-cap when necessary.
  

Education/Experience

• Must have three years of claims processing and or auditing experience.
  
• Internal/external audit experience is preferred
  
• Proficient in medical terminology, CPT, ICD9, Revenue codes, HCPCS codes
  
• Experience with EZ-CAP system claims module.
  
• Required Education: Associate's or Bachelor's