Benefits Administrator
To see similar active jobs please follow this link: Remote Administration jobs
For over 30 years, AllWays Health Partners has delivered value to our members and worked to improve access to care and coverage. As a member of Mass General Brigham, AllWays is a health plan at the forefront of innovation, advancing a highly integrated model of value-based care with one of the world's leading health care systems. Together, we are transforming the customer experience, keeping our members and patients at the center of everything we do. Bring your unique talents and join us as we strive to create a world where all people live healthier lives.
Reporting to the Manager, Benefits Administration, the Benefits & Coding Administrator II works with the Benefits Administration Team to support the accurate and effective implementation of benefits across all products.
Essential Functions
• Evaluate benefit configuration in collaboration with IT Configuration and Claims staff, ensuring that benefit configuration aligns with the approved business requirements and plan materials.
• Contribute to business discussions re: benefit coverage and configuration, drawing on claims experience, knowledge of regulatory requirements, industry standards re: coding and billing, and payer benchmarking for ad hoc and system-wide decisions.
• Support the maintenance and enhancement of benefit information in KCII (Knowledge Center II).
• Represent Benefits Administration as a subject matter expert on corporate projects, committees or workgroups.
• Provide technical business summaries on selected benefit topics in support of work required to develop and maintain benefits as required for specific program and plan requirements.
• Provide research and benchmarking on services and items represented by new codes as released quarterly; leading the code load process including the presentation at the Benefit & Coding Committee and business requirements submission to IT Configuration
• Lead coding and coverage discussions on operational work and selected projects; working with colleagues from key areas including: Product Management, Compliance, Provider Reimbursement, Provider Payment Integrity, IT Configuration, Clinical, Pharmacy, Customer Service and Claims.
• Contribute to benefit property development or modification in the integrated care administrative transaction system (QNXT) by coordinating business requirements with configuration requirements.
• Monitor the accuracy of benefit information in member materials, working with the Product Management team and other stakeholders as needed.
• Work with Benefits Administration Team to maintain the accuracy of benefit information provided to internal teams via the Benefit Clarification process and the Knowledge Center application.
• Enhancing KCII (Knowledge Center II) to support more efficient communication of benefit coverage; collaborating with Customer Service on updates.
• Maintain the Code Search Look Up feature with quarterly updates and benefit changes.
• Evaluate the Benefit Clarification Library to identify prioritized updates for QNXT and/or KCII.
• Participate in Benefit & Coding Committee meetings and other meetings as assigned.
• Hold self and others accountable to meet commitments.
• Build strong customer relationships and deliver solutions that meet customer expectations; establish and maintain effective customer relationships - both internal as well as external.
• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate AllWays Health Partners as a people-first organization.
• Other duties as assigned with or without accommodation.
Working Conditions and Physical Effort
• Work is performed in a remote environment.
Qualifications
Minimum Requirements
Knowledge and Education
Required:
• Certified Professional Coder (CPC) certification required or experience with and an understanding of ICD 9, ICD 10, CPT, HCPCS codes along with other claims billing requirements
• Associates Degree in health science administration, business or health care related field.
Preferred/Desired:
• Bachelor's Degree.
• Knowledge of and experience with Medicare Advantage plan coverage.
• Knowledge of health insurance contracts and benefits, managed care products, HMO, PPO or health insurance benefit design.
• Working knowledge of healthcare regulation at a State and Federal level.
• Knowledge of Medicaid and Commercial health insurance products.
Experience
Required:
• Three years' experience in valuing the impact of benefit coverage decisions with support of analytics preferred.
• Minimum of 3 years' experience in a related role required
Preferred/Desired:
• 3 years experience Medicare Advantage health plan or related role.
Skills/Competencies
• Excellent technical skills including ability to navigate the Microsoft suite of products (i.e., Word, Excel, and Sharepoint).
• Excellent written and oral communication skills including technical writing for cross functional teams.
• Ability to prioritize work and operate under tight deadlines
• Demonstrate AllWays Health Partners' core brand principles of always listening, challenging conventions, and providing value.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it's needed.
• Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.
• Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
• Be accountable for delivering high-quality work. Act with a clear sense of ownership.
• Bring fresh ideas forward by actively listening to and working with employees and the people we serve.
EEO Statement
Our promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.
Disclaimer
The above statements are intended to describe the general nature and complexity of the work being performed by personnel assigned to this classification and do not represent an exhaustive list of all tasks, duties, and responsibilities required of personnel assigned to this position.
About the job
Benefits Administrator
To see similar active jobs please follow this link: Remote Administration jobs
For over 30 years, AllWays Health Partners has delivered value to our members and worked to improve access to care and coverage. As a member of Mass General Brigham, AllWays is a health plan at the forefront of innovation, advancing a highly integrated model of value-based care with one of the world's leading health care systems. Together, we are transforming the customer experience, keeping our members and patients at the center of everything we do. Bring your unique talents and join us as we strive to create a world where all people live healthier lives.
Reporting to the Manager, Benefits Administration, the Benefits & Coding Administrator II works with the Benefits Administration Team to support the accurate and effective implementation of benefits across all products.
Essential Functions
• Evaluate benefit configuration in collaboration with IT Configuration and Claims staff, ensuring that benefit configuration aligns with the approved business requirements and plan materials.
• Contribute to business discussions re: benefit coverage and configuration, drawing on claims experience, knowledge of regulatory requirements, industry standards re: coding and billing, and payer benchmarking for ad hoc and system-wide decisions.
• Support the maintenance and enhancement of benefit information in KCII (Knowledge Center II).
• Represent Benefits Administration as a subject matter expert on corporate projects, committees or workgroups.
• Provide technical business summaries on selected benefit topics in support of work required to develop and maintain benefits as required for specific program and plan requirements.
• Provide research and benchmarking on services and items represented by new codes as released quarterly; leading the code load process including the presentation at the Benefit & Coding Committee and business requirements submission to IT Configuration
• Lead coding and coverage discussions on operational work and selected projects; working with colleagues from key areas including: Product Management, Compliance, Provider Reimbursement, Provider Payment Integrity, IT Configuration, Clinical, Pharmacy, Customer Service and Claims.
• Contribute to benefit property development or modification in the integrated care administrative transaction system (QNXT) by coordinating business requirements with configuration requirements.
• Monitor the accuracy of benefit information in member materials, working with the Product Management team and other stakeholders as needed.
• Work with Benefits Administration Team to maintain the accuracy of benefit information provided to internal teams via the Benefit Clarification process and the Knowledge Center application.
• Enhancing KCII (Knowledge Center II) to support more efficient communication of benefit coverage; collaborating with Customer Service on updates.
• Maintain the Code Search Look Up feature with quarterly updates and benefit changes.
• Evaluate the Benefit Clarification Library to identify prioritized updates for QNXT and/or KCII.
• Participate in Benefit & Coding Committee meetings and other meetings as assigned.
• Hold self and others accountable to meet commitments.
• Build strong customer relationships and deliver solutions that meet customer expectations; establish and maintain effective customer relationships - both internal as well as external.
• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate AllWays Health Partners as a people-first organization.
• Other duties as assigned with or without accommodation.
Working Conditions and Physical Effort
• Work is performed in a remote environment.
Qualifications
Minimum Requirements
Knowledge and Education
Required:
• Certified Professional Coder (CPC) certification required or experience with and an understanding of ICD 9, ICD 10, CPT, HCPCS codes along with other claims billing requirements
• Associates Degree in health science administration, business or health care related field.
Preferred/Desired:
• Bachelor's Degree.
• Knowledge of and experience with Medicare Advantage plan coverage.
• Knowledge of health insurance contracts and benefits, managed care products, HMO, PPO or health insurance benefit design.
• Working knowledge of healthcare regulation at a State and Federal level.
• Knowledge of Medicaid and Commercial health insurance products.
Experience
Required:
• Three years' experience in valuing the impact of benefit coverage decisions with support of analytics preferred.
• Minimum of 3 years' experience in a related role required
Preferred/Desired:
• 3 years experience Medicare Advantage health plan or related role.
Skills/Competencies
• Excellent technical skills including ability to navigate the Microsoft suite of products (i.e., Word, Excel, and Sharepoint).
• Excellent written and oral communication skills including technical writing for cross functional teams.
• Ability to prioritize work and operate under tight deadlines
• Demonstrate AllWays Health Partners' core brand principles of always listening, challenging conventions, and providing value.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it's needed.
• Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.
• Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
• Be accountable for delivering high-quality work. Act with a clear sense of ownership.
• Bring fresh ideas forward by actively listening to and working with employees and the people we serve.
EEO Statement
Our promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.
Disclaimer
The above statements are intended to describe the general nature and complexity of the work being performed by personnel assigned to this classification and do not represent an exhaustive list of all tasks, duties, and responsibilities required of personnel assigned to this position.