Peak Health

• Test and maintain health insurance benefit plans in the company's systems, ensuring accuracy and compliance with regulatory requirements. • Conduct regular audits and reviews of benefit configurations to identify discrepancies, inconsistencies, or errors. • Resolve configuration errors in a timely manner and document changes. • Work closely with IT teams to ensure seamless integration of benefit configurations into the company's technology platforms. • Maintain comprehensive documentation for benefit configuration, ensuring that processes and procedures are well-documented. • Evaluate and validate all medical billing codes, various coding services and align to accurate benefit coding. • Perform audits on all clinical documents and prepare coding to provide support to all services. • Perform research on various coding methods and facilitate all plans to resolve all discrepancies and coordinate with all clinical and non-clinical groups to manage documents according to required guidelines. • Administer review of professional billing systems and perform research to resolve all coding errors and evaluate all claims work queues. • Review procedure code master file and evaluate authenticity of all entries and evaluate all through efficient usage of codes. • Analyze and maintain all code master files for all inappropriate codes and inform staff for same and collaborate with staff to resolve all coding issues and ensure accuracy of same. • Perform testing of coding and policy changes via reports, claim adjudication and other testing software. • Manage and resolve all discrepancies in entry of codes and maintain knowledge on all procedural codes and reimbursement plans and prepare reports for all coding guidelines. • Maintain knowledge and compliance of CMS (Center for Medicare Services) guidelines and coding/billing processes. Ensure compliance with other insurance governance agencies. • Participate in and support all training in regard to new benefit designs or benefit changes as the result of CMS or other insurance regulations.

• Assists with the development, scaling, improvement, and maintenance of data models, dashboards, and analytical solutions supporting Peak Health operations • Leverages complex analytical tools to provide business and technical expertise to create data driven solutions. • Partners with product, operations, medical management, and provider contracting teams to understand & anticipate reporting requirements, priorities, and key performance indicators. • Supports key business stakeholders, translating data into actionable insights using appropriate analytical solutions. • Produces repeatable and ad-hoc reports for key business stakeholders to measure and interpret business trends. • Participates in a variety of assigned operations initiatives to ensure success in meeting business goals and objectives. • Collects report requirements – interviews and researches business stakeholder needs; drafts, edits and validates requirement documentation. • Provides input on project plans, scope of work, status, and project summary reports. • Communicates results of analysis effectively and regularly to business stakeholders. • Other duties as assigned.

• Assists with the development, scaling, improvement, and maintenance of data models, dashboards, and analytical solutions supporting Peak Health operations • Leverages complex analytical tools to provide business and technical expertise to create data driven solutions • Partners with health plan leadership, product, operations, medical management, and provider contracting teams to understand & anticipate reporting requirements, priorities, and key performance indicators • Provides thought leadership to key business stakeholders, translating data into actionable insights using appropriate analytical solutions • Produces repeatable and ad-hoc reports for key business stakeholders to measure and interpret business trends • Participates in a variety of assigned operations initiatives to ensure success in meeting business goals and objectives • Provides mentoring and guidance to Business Intelligence Engineers on processes and practices related to repeatable and ad-hoc reports, defining business cases, and supporting key business stakeholders • Collects report requirements – interview and research business stakeholder needs; draft, edit and validate requirement documentation • Provides input on project plans, scope of work, status, and project summary reports • Provides input on strategies and tactics regarding platforms, tools, and technical staffing to meet customer needs • Communicates results of analysis effectively and regularly to business stakeholders

• Designs, builds and maintains operational processes, policies and procedures to support Claims processing • Partners with IT and other leaders to develop business requirements to support core administration system deployment • Recruits, trains and develops a highly engaged team of claims processors • Claims inventory management and load balancing to meet contractual and organizational objectives • Anticipates future demands of initiatives related to people, process and technology and works with leadership to design and implement solutions to these needs • Collaborates with IT, Enrollment, Medical Management, Member & Provider Services and Finance to identify and implement processes to drive continuous improvement • Continually assesses activities and processes to ensure efficiency and added value

• Performs a wide range of professional accounting functions in accordance with Generally Accepted Accounting Principles (GAAP) and Statutory Accounting Principles (SAP). • Supports the month-end financial statement process of Peak Health entities. • Completes documentation and schedules during month-end, budget preparation, and external audit. • Provides financial guidance to department managers to help control costs and provide organization-wide efficiencies.

• Determines accuracy and completions of claim information. Entry/verifies claims data. • Resolves claim edits, review history records, and determine benefit eligibility for service. • Reviews payment levels to arrive at final payment determination. • Meets all production and quality standards, maintaining workques according to department standards. • Effectively communicates with internal and external staff. • Elevates issues to next level of supervision, as appropriate. • Ensures accuracy of data entered and record maintenance. • Attends all required training classes, demonstrating proficiency and ability to learn.