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 accuracy and adherence to regulatory requirements.

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

• Resolve configuration errors promptly and document any changes made.

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

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

• Evaluate and validate all medical billing codes, various coding services, and ensure alignment with accurate benefit coding.

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

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

• Administer reviews of professional billing systems and conduct research to resolve coding errors while evaluating all claims work queues.

• Review the procedure code master file, assessing the authenticity of all entries and ensuring efficient usage of codes.

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

• Test coding and policy changes through reports, claim adjudication, and other testing software.

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

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

• Participate in and support all 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.

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

• Ability to think strategically and independently.

• Demonstrated knowledge of federal and state insurance guidelines, including those from CMS and others.

• Proficiency in Microsoft Office applications.

• Strong attention to detail, organizational skills, and the capability to manage multiple tasks simultaneously.

🏝️ Benefits

• Health insurance

• Paid time off

• Professional development opportunities

• Potential travel required for offsite meetings