Benefits Configuration Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Test and maintain health insurance benefit plans within the company's systems, ensuring both accuracy and compliance with regulatory standards.

• Conduct regular audits and evaluations of benefit configurations to pinpoint discrepancies, inconsistencies, or errors.

• Timely resolve configuration errors and thoroughly document any changes made.

• Collaborate closely with IT teams to ensure the smooth integration of benefit configurations into the company's technology platforms.

• Maintain detailed documentation for benefit configuration, ensuring all processes and procedures are well-documented.

• Assess and validate medical billing codes and various coding services, ensuring alignment with accurate benefit coding.

• Conduct audits on all clinical documents and prepare coding to support all services provided.

• Research various coding methods and facilitate plans to resolve discrepancies, coordinating with both clinical and non-clinical teams to manage documents according to required guidelines.

• Oversee the review of professional billing systems and perform research to rectify coding errors while evaluating all claims work queues.

• Review the procedure code master file, assessing the authenticity of all entries and evaluating their usage efficiently.

• Analyze and maintain all code master files to identify inappropriate codes, informing staff and collaborating to resolve coding issues, ensuring their accuracy.

• Perform testing of coding and policy changes through reports, claim adjudication, and various testing software.

• Manage and resolve discrepancies in code entries while maintaining knowledge of procedural codes and reimbursement plans, preparing reports for all coding guidelines.

• Stay updated with and ensure compliance with CMS (Center for Medicare Services) guidelines and coding/billing processes, as well as regulations from other insurance governance agencies.

• Actively participate in and support training related to new benefit designs or changes resulting from CMS or other insurance regulations.

⛳️ Requirements

• Associate degree in health information, healthcare, or a related field AND one (1) year of experience in health insurance, medical coding, claims processing, or a related area.

• High School Diploma or equivalent AND three (3) years of experience in health insurance, medical coding, claims processing, or a related area.

• Bachelor’s degree in health information, healthcare, or a related field is preferred.

• Six (6) years of experience in health insurance and benefit design.

• Knowledge of federal and state insurance guidelines including those from CMS and other organizations.

• Proficiency in Microsoft Office applications.

🏝️ Benefits

• Health insurance coverage

• Standard office environment

• Opportunities for professional development

• Paid time off

• Possible travel for offsite meetings