REQUIRED SKILLS:
Reimbursement and Audit:
* Bachelor's Degree in Business Administration, Finance, Accounting, Computer Science or related field.
* Two (2) years systems analyses experience required which includes one year (1) year of medical claim systems configuration and/or pricing analyses.
* One (1) year experience using diagnosis and procedure coding systems (for example CPT, MUPC, HCPCS and ICD-9) with regard to hospital or medical claims billing and processing.
* One (1) year database management software and PC experience.
* Ability to perform detailed financial analysis, complex pricing, system research/analysis, reconciliation, provide solutions and/or develop audit reports.
* High degree of complex evaluative, analysis and problem solving.
* Advanced knowledge of Microsoft Office Suite software (Access, Excel, and Word) required; Business Object and Facets preferred.
* Excellent verbal and written communication skills.
* Knowledge of HMO procedures preferred.
* Other skills and abilities may be required.
* Thorough understanding of managed care physician provider reimbursement and risk funding arrangements preferred.
* Detailed knowledge of claims, pricing, benefits and provider mainframe computer systems required, including BCN mainframe claims subsystem (Facets) interaction preferred.
* Knowledge of funding arrangements between BCN and IPAs preferred.
* Demonstrated knowledge of claim processing system analysis and configuration preferred.