Offer summary

Qualifications:

Bachelor's degree in a related field or equivalent work experience required., Minimum of five years of medical benefit plan design and/or configuration experience required., Advanced knowledge of CPT, HCPCs, and ICD-CM Codes preferred., Certified Coding Professional certification preferred..

Key responsabilities:

Create and maintain benefit grids and configuration templates to ensure accuracy of benefit requirements.

Communicate with internal departments to promote process improvement and resolve issues.

Lead cross-functional meetings and assist in training new hires.

Analyze data and create reports to support issue resolution and impact analysis.

Job description

Job Summary:

The Benefit Support Analyst III is responsible for reviewing and breaking down complex medical business requirements into configurable requirements and working with configuration and other partners in helping to develop the strategic direction of member benefits across all states and product lines. Certified Coding Professional certification preferred.

Essential Functions:

Create and maintain benefit grids with annual and ad hoc changes
Create, maintain, review, and analyze configuration templates to validate benefit requirements and regulations are accurate; collaborate with policy and markets to confirm and resolve conflicts
Perform peer review of configuration templates and provide documentation of results within the defined SLA guidelines; identify and implement opportunities for process improvement
Communicate effectively with various internal departments to enhance cross-functional awareness, promote process improvement, and identify root cause resolution of issues
Participate in the annual benefit change process with Product Management and Benefit Analysts as appropriate per market
Create and utilize reports to analyze data to assist with issue resolution and impact analysis
Adhere to defined SLAs while also accommodating urgent requests
Incorporate critical thinking skills, discretion, and independent judgement into the analysis process to determine the best course of action for each issue/task
Create and maintain SOPs and supporting process flows
Provide guidance and mentorship to teammates/peers
Update and maintain the data management tool
Lead and facilitate cross functional or project meetings as assigned
Assist in the training and development of new hires and continuous training for peers
Manage the Quarterly Code Process across multiple teams for all LOB’s
Lead and/or participate in projects as assigned
Act as Back up to Team Lead, Triage Analyst and all BA functions as needed
Perform any other job-related instructions as requested

Education and Experience:

Bachelor's degree in a related field or equivalent years of relevant work experience is required
Minimum of five (5) years of medical benefit plan design and/or configuration experience is required
Configuration experience (Facets or equivalent system) preferred
Managed Care or healthcare experience is preferred

Competencies, Knowledge and Skills:

Advanced computer skills with Microsoft Suite
Proven understanding of database relationships preferred
Advanced knowledge of CPT, HCPCs and ICD-CM Codes preferred
Working knowledge of other claims related reference data, such as types of bill, revenue codes, places of service
Proven understanding of the upstream and downstream impacts of code level benefit details
Problem solving skills
Communication skills, both written and verbal
Ability to work independently and within a team environment
Attention to detail
Knowledge of Medicare, Medicaid or Marketplace medical insurance benefits preferred
Claims processing knowledge preferred
Ability to work in a fast-paced environment managing multiple priorities
Ability to build and maintain strong working relationships with cross-functional teams
Knowledge of regulatory requirements of Outpatient Prospective Payment System (OPPS) and other payer requirements preferred
Ability to break down complex benefit requirements
Excellent organizational skills and ability to meet deadlines
Strong interpersonal skills and high level of professionalism
Facets or other systems knowledge/training preferred
Decision making/problem solving skills

Licensure and Certification:

AAPC Coding designation preferred

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$70,800.00 - $113,200.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies