Benefit Coding Analyst

Job Summary

The Benefit Coding Specialist is a position responsible for accurate and timely implementation and ongoing building of benefit plans into the claims system. This position will also be responsible for performing quality assurance reviews and testing as required. Serve as the subject matter expert for the implementation of customer benefit designs into applicable systems.

Essential Functions:

• The essential functions listed represent the major duties of this role, additional duties may be assigned.
• Maintain benefit coding configuration for group health plans: (80%)
  - Read and interpret a Summary Plan Document and translate into a plan profile to facilitate the system set up process.
  - Revision of benefit plan design as needed to update for Client and regulated changes
  - Share best practices with other team members and ensure consistent handling of tasks
  - Partner with Claims Managers and Team Leads to facilitate benefit processes and coordinate testing of completed plans
• Execute communications both internally and externally: (15%)
  - Provide customer service externally to our clients
  - Provide customer service internally to our customer service, claims and account management departments
  - Act as the "trouble shooting liaison" between the Benefit Coding and Claims team
• Metrics and Performance: (5%)
  - Follow established metrics for quality, relevance, and accuracy
  - Meet metrics and client performance guarantees
  - Identify and raise with manager continued improvement/training needs
  - Assist in developing and improving existing processes and tools
  - Track and resolve issues regarding plan set up, benefit clarifications and benefit changes
  - Work with manager to identify enhancements that would streamline processes

Required Work Experience:

• 3+ years related work experience.
• Working knowledge of CPT, HCPCS, Revenue and ICD10 codes.
• Claims administrative industry experience and Claims processing experience.

Education:

• Related Bachelor's degree in Health Administration preferred. Or additional related equivalent work experience.

Additional Required Qualifications:

• Minimum of 3 years claims administrative industry experience.
• Microsoft Word, Excel, Access, and Windows; Customized Programs for Medical CPT and ICD coding.
• Excellent attention to detail and organizational skills.
• Excellent verbal and written communication skills.
• Ability to think outside the box.
• Ability to adapt to changing requirements and handle multiple tasks.

General Physical Demands:

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.