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Job Details

Benefits Coverage Analyst Healthcare

Company name
Experian Information Solutions, Inc.

Location
Nashville, TN

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Profile

Benefits Coverage Analyst (Healthcare)

Experian

Nashville

TN

Job #663242139

Description

At Experian Health, our employees have the opportunity to shape more than products – they shape the future of U.S. healthcare. Experian Health is a pioneer for innovations leading the way in revenue cycle management, identity management, patient engagement, and care management for hospitals, physician groups, labs, pharmacies and other risk-bearing entities. Our success relies on people who are given the freedom to imagine new frontiers in the rapidly changing healthcare space and push the boundaries of innovation. Help us realize our vision of applying data for good and changing the healthcare landscape for the better – for all of us.

Utilizing Healthcare Revenue Cycle knowledge, you will be responsible for researching and analyzing coverage polices for Medicare, Medicaid and/or Commercial payers and creating data tables reflecting payer edits which are used by Experian Health applications

Research Coverage Determination policies for Medicare, Medicaid and/or Commercial Payers; maintain edit tables with changes.

Maintain payers by performing manual checks on a monthly/weekly basis for required payers

Analyze, Extract & document coverage positions and medical necessity coding combinations from commercial carriers’ policies

Create and maintain Excel data tables representing payer specific edit

Make determinations of how changes apply to edit table

Respond to client case

Become familiar with internal loading system processes

Become familiar with Verification processes of loaded edit tables, ensuring defined QA & verification process are understood

Knowledge, Experience & Qualifications

Required, 1-2 yrs healthcare billing/reimbursement/benefits experience

Familiarity with x12 and HL7 strongly preferred

Basic knowledge of managed care payer edits or Medicare edit tables and impact on products

Demonstrated SQL background with basic understanding

Demonstrated skill in using Excel’s basic functions (i.e., true/false, etc…)

Demonstrated skill in gathering, analyzing, inputting, and manipulating basic healthcare data

Demonstrated ability to analyze medical and reimbursement policies to determine application of coding basic edits

Experian is the leading global information services company, providing data and analytical tools to our clients around the world. We have always believed that data has the potential to transform lives and create a better tomorrow. We are transforming data into something meaningful: helping businesses to manage credit risk, preventing fraud, targeting marketing offers and automating decision making. We have been named one of the “World’s Most Innovative Companies” by Forbes for 3 years in a row, operating at the center of Big Data since before the phrase was coined. Few companies can offer information services on an equivalent scale. We support clients in more than 80 countries and employ approximately 17,000 people in 37 countries.

Experian is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner. The word Experian is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies.

Description

At Experian Health, our employees have the opportunity to shape more than products – they shape the future of U.S. healthcare. Experian Health is a pioneer for innovations leading the way in revenue cycle management, identity management, patient engagement, and care management for hospitals, physician groups, labs, pharmacies and other risk-bearing entities. Our success relies on people who are given the freedom to imagine new frontiers in the rapidly changing healthcare space and push the boundaries of innovation. Help us realize our vision of applying data for good and changing the healthcare landscape for the better – for all of us.

Utilizing Healthcare Revenue Cycle knowledge, you will be responsible for researching and analyzing coverage polices for Medicare, Medicaid and/or Commercial payers and creating data tables reflecting payer edits which are used by Experian Health applications

Research Coverage Determination policies for Medicare, Medicaid and/or Commercial Payers; maintain edit tables with changes.

Maintain payers by performing manual checks on a monthly/weekly basis for required payers

Analyze, Extract & document coverage positions and medical necessity coding combinations from commercial carriers’ policies

Create and maintain Excel data tables representing payer specific edit

Make determinations of how changes apply to edit table

Respond to client case

Become familiar with internal loading system processes

Become familiar with Verification processes of loaded edit tables, ensuring defined QA & verification process are understood

Knowledge, Experience & Qualifications

Required, 1-2 yrs healthcare billing/reimbursement/benefits experience

Familiarity with x12 and HL7 strongly preferred

Basic knowledge of managed care payer edits or Medicare edit tables and impact on products

Demonstrated SQL background with basic understanding

Demonstrated skill in using Excel’s basic functions (i.e., true/false, etc…)

Demonstrated skill in gathering, analyzing, inputting, and manipulating basic healthcare data

Demonstrated ability to analyze medical and reimbursement policies to determine application of coding basic edits

Experian is the leading global information services company, providing data and analytical tools to our clients around the world. We have always believed that data has the potential to transform lives and create a better tomorrow. We are transforming data into something meaningful: helping businesses to manage credit risk, preventing fraud, targeting marketing offers and automating decision making. We have been named one of the “World’s Most Innovative Companies” by Forbes for 3 years in a row, operating at the center of Big Data since before the phrase was coined. Few companies can offer information services on an equivalent scale. We support clients in more than 80 countries and employ approximately 17,000 people in 37 countries.

Experian is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner. The word Experian is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies.

Experian is an Equal Opportunity Employer including disability / veteran.

Updated 05/16/2018

Company info

Experian Information Solutions, Inc.
Website : http://www.experian.com/

Company Profile
We are the leading global information services company, providing data and analytical tools to our clients around the world. We help businesses to manage credit risk, prevent fraud, target marketing offers and automate decision making. We also help people to check their credit report and credit score, and protect against identity theft. In 2015, we were named by Forbes magazine as one of the “World’s Most Innovative Companies.” We employ approximately 17,000 people in 37 countries and our corporate headquarters are in Dublin, Ireland, with operational headquarters in Nottingham, UK; California, US; and São Paulo, Brazil. Experian plc is listed on the London Stock Exchange (EXPN) and is a constituent of the FTSE 100 index. Total revenue for the year ended March 31, 2015, was US$4.8 billion.

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