Responsible for assisting in the ongoing configuration, management and oversight in the Facets system related to Benefits, Finance, Pricing and Workflow Configuration. Assists in the configuration and management of specified programs, products and services in one of the four major areas within configuration. Helps ensure continued operational functionality and accuracy of the Facets system that will in turn lead to membership retention, growth and member and provider satisfaction.
Reviews and interprets benefit documents to configure benefits at all levels of detail.
Designs, configures and tests benefits according to Health Plan and industry coding schemes.
Gathers data, investigates and resolves system benefit configuration issues and problems, including reconfiguration and testing.
Communicates resolution of issues with impacted areas.
Documents system benefit configuration, including necessary changes.
Responsible for the design and creation of Finance Configuration including but not limited to correct provider payment via the 835 process, capitation, group set up, premium rate tables, monthly billing and dunning.
Review and interpret GICs and excel configuration document requests for small business, exchange group and individual PPO received from internal the Health Plan business teams for configuration.
Partners with Finance Business teams to help resolve questions, concerns and issues for new or updated configuration needs.
Assist with troubleshooting and resolution related to monthly billing issues.
Initiates proper financial terms and accurate set up of contractual arrangements in the pricing module.
Interfaces with Provider Network Management and Contract Administration to ensure proper interpretation of unclear, unstated or obscure scenarios found in provider contracts and pricing agreements.
Develops appropriate communication methods and standards for dissemination of pricing configuration information for new, modified, enhanced or fixed pricing agreements.
Assures that pricing configuration development and enhancement conforms to defined standards.
Directs and monitors workload for development of pricing configuration in system applications considering total resources and time frame parameters.
Creates and maintains documentation of pricing set up and configuration.
Responsible for training members of Customer Service Support Team on pricing policies and procedures.
Responsible for the design and creation of Workflow Configuration according to the Health Plan business standards and governmental regulations.
Creates and maintains documentation of Workflow set up and configuration, including new and changing configuration.
Investigate and resolve workflow configuration issues, including reconfiguration and testing.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
*Relevant experience may be a combination of related work experience and degree obtained (Associate's Degree = 2 years; Bachelor's Degree = 4 years).
High School Diploma or Equivalent (GED)- (Required)
Minimum of 4 years-Relevant experience* (Required)
Certification(s) and License(s)
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencingprograms, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13... hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers. What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.