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Job Details

Business Analyst, Code Auditing

Requisition #: 194464
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Non-Clinical Professional
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Nov. 1, 2019

Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.

This position reports to the Director of Operations Support and is responsible for the implementation, maintenance and optimization of the code auditing software (McKesson ClaimCheck®) for all lines of business/claims systems, and it’s derivatives for business solutions for operations. The Business Analyst for code auditing will take responsibility for coordinating business decisions and integrating future-state workflow designs for code auditing software to support strategic objectives; and ensure information technology supports business practices and financial integrity in current and prospective claims systems. The Business Analyst will assist with implementation of information systems solutions to promote strategies to enhance claims processing and assures that all customers are equipped with the knowledge, skills, and equipment to maximize their use of the systems.

Requirements:

  1. Education:

Requires a Bachelor’s Degree in Business, HealthCare Management or related field preferred. Additional related work experience may substitute for some educational requirements.

B. Knowledge:

Extensive knowledge of claims processing operations and code auditing rationale; preferred knowledge of McKesson ClaimCheck® software including the policy administration module (PAM) and or the Optum Claims Editing System. Demonstrated ability to define data analysis requirements and propose formats and strategies for answering business questions related to operations and systems configuration. Ability to work with vendor and internal project team for ClaimCheck® post-implementation support and function. Work requires extensive knowledge in planning, monitoring, measuring and reporting on data analysis and delivery projects.

Knowledge of managed care operations and medical coding (CPT, ICD9, ICD10, DME, HCPCS)

Work requires knowledge of the managed care environment, operations and claims as acquired during a minimum of 5 years of related experience. Knowledge of data analysis, reporting, and use of data to make key decisions is necessary.

C. Skills:

Strong oral and written communication skills are required.

Requires strong analytical skills to resolve issues quickly, make decisions, and to make recommendations, communicate, and institute change when appropriate.

Must be very detailed oriented and be able to maintain focus while working with code auditing software and data reports.

Experience with MS Office including Excel and SQL, McKesson Claim Check® and/or Optum CES and claims systems (preferably MC400, HEALTHsuite). Ability to make effective presentations to internal and external groups.

D. Required Licensure, Certification, Etc.:

Certified Professional Coder (CPC) preferred

E. Work Experience:

Requires five to seven years of experience in the healthcare industry including 3 years with claims processing / code auditing within a managed care environment.

Previous experience with McKesson ClaimCheck and/or Optum CES code auditing software, and CPT/HCPCS/ICD9 coding, is strongly preferred.

F. Machines, Tools, Equipment:

Must be able to operate a PC, PC applications, and general office and communications equipment

Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.

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