Benefit Plan Configuration Analyst (Updated: 9/6/2023 6:57:42 AM)
MISSION
Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.
VALUES
HealthOne is guided by a cultural framework that embodies our values and drives our decisions.
Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.
HealthOne seeks individuals with integrity and heart to embody our values. Whether you’re starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.
JOB PURPOSE
The Benefit Plan Configuration Analyst position specializes in the analysis and application of intermediate level benefit plan design requirements. A successful Analyst will ensure a high level of quality and accuracy through benefit configuration, test execution and validation efforts while serving as a subject matter expert on benefits and claim adjudication system coding setup.
ESSENTIAL JOB DUTIES
• Analyzes new business requirements for benefit design changes to establish the appropriate solution.
• Complies with standards set forth regarding benefit design and configuration including but not limited to Health Insurance Portability and Accountability Act of 1996 (HIPAA) and National Council for Prescription Drug Programs (NCPDP).
• Maintains technical documentation based on standard operating procedures.
• Partners with various teams to analyze customer specific requirements and configuration and translate those into technical design specification and data flow from which programs are developed and coded.
• Actively participates in and contributes to daily communications, team meetings and project/issue resolution.
• Responsible for accurate management of plan benefits coding changes, test execution and validation efforts of plan benefit design requests.
• Maintains documentation that validates configuration.
• Efficiently and effectively distributes tasks, using clear and concise instructions and expectations.
• Completes deliverables independently and within an agile team setting.
• Assists with the dictionary/master file maintenance such as research, set up and maintenance of all Diagnosis, CPT, and other medical code sets
• Assists with updates and maintains adjudication system with defined code sets in logical order
• Coordinates with internal departments to ensure data accuracy
• Supports maintenance of group/benefit additions, terms, changes
• Runs existing testing scripts for new and existing plans
• Assists in the on-going evaluation of the benefit configurations within the core claim processing system for new and existing benefit plans
• Documents the configuration of new plans as well as changes in existing plans
• Provides feedback to Configuration Analyst II regarding feasibility and requirements for enhancements to benefit configuration
• Provides research assistance for the resolutions of benefit issues
• Serves as a liaison of benefit configuration to external departments
• Collects and analyzes data to evaluate operational difficulties and makes recommendations to solve problems
• Supports the work to troubleshoot and resolves claims that suspend in work queues for configuration intervention in the claims processing system
• Audits files and/or batch load entries for accuracy
• Performs a variety of tasks related to the on-going maintenance and set up of client configurations with the core administrative system
• Assists with client implementations, system upgrades and projects to improve performance
• Participates in problem solving of provider, client, reporting or system issues
• Potential to rotate through configuration support functions across key system areas and lines of business with the ability to develop subject matter expertise
• Performs special projects as needed and other duties related to system and report data integrity Analyzes new business requirements for benefit design changes to establish the appropriate solution.
• Complies with standards set forth regarding benefit design and configuration including but not limited to Health Insurance Portability and Accountability Act of 1996 (HIPAA) and National Council for Prescription Drug Programs (NCPDP).
• Maintains technical documentation based on standard operating procedures.
• Partners with various teams to analyze customer specific requirements and configuration and translate those into technical design specification and data flow from which programs are developed and coded.
• Actively participates in and contributes to daily communications, team meetings and project/issue resolution.
• Responsible for accurate management of plan benefits coding changes, test execution and validation efforts of plan benefit design requests.
• Maintains documentation that validates configuration.
• Efficiently and effectively distributes tasks, using clear and concise instructions and expectations.
• Completes deliverables independently and within an agile team setting.
• Assists with the dictionary/master file maintenance such as research, set up and maintenance of all Diagnosis, CPT, and other medical code sets
• Assists with updates and maintains adjudication system with defined code sets in logical order
• Coordinates with internal departments to ensure data accuracy
• Supports maintenance of group/benefit additions, terms, changes
• Runs existing testing scripts for new and existing plans
• Assists in the on-going evaluation of the benefit configurations within the core claim processing system for new and existing benefit plans
• Documents the configuration of new plans as well as changes in existing plans
• Provides feedback to Configuration Analyst II regarding feasibility and requirements for enhancements to benefit configuration
• Provides research assistance for the resolutions of benefit issues
• Serves as a liaison of benefit configuration to external departments
• Collects and analyzes data to evaluate operational difficulties and makes recommendations to solve problems
• Supports the work to troubleshoot and resolves claims that suspend in work queues for configuration intervention in the claims processing system
• Audits files and/or batch load entries for accuracy
• Performs a variety of tasks related to the on-going maintenance and set up of client configurations with the core administrative system
• Assists with client implementations, system upgrades and projects to improve performance
• Participates in problem solving of provider, client, reporting or system issues
• Potential to rotate through configuration support functions across key system areas and lines of business with the ability to develop subject matter expertise
• Performs special projects as needed and other duties related to system and report data integrity
• Maintains regular and predictable attendance
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
• Works to encourage and promote Company culture throughout the organization
• Other duties as may be assigned
QUALIFICATIONS
• Up to 2 years of experience in benefit plan configuration/analysis.
• Experience with adjudication processes, analyzing benefit plan design and system application.
• This role requires strong attention to detail, critical thinking, and analytical skills
• Proficiency in Microsoft Office Suite including Outlook, Word, Excel, and PowerPoint
• Ability to work within a team and as an individual contributor in a fast-paced, changing environment.
• Ability to identify and resolve process and/or systems issues.
• Strong sense of urgency leading to the timely completion of all projects, training, and assignments.
• High School Diploma or GED required
• Associates or Bachelor's degree in a business or computer-related field preferred
• Knowledge of ICD-10, CPT4 Coding, HCPCS and medical terminology
• Three or more years of Healthcare experience
• Three or more years of working around claims implementation and analysis and/or claims configuration experience in any one of these areas: Provider/Provider Contracting, Clinical Benefits, Enrollment and Billing
• Coding Certificate preferred
PHYSICAL REQUIREMENTS
Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.
BENEFITS
401K (4% Match, Immediate Vesting)
Accident insurance
Competitive salary
Critical Illness Insurance
Dental Insurance
Employee Assistance Program
Flexible Spending Account
Health & Wellness Program
Health Savings Account
Life & AD&D Insurance
Long Term Disability
Medical Insurance
Paid Time Off
Pet Insurance
Short Term Disability
Vision Insurance
PRE-EMPLOYMENT SCREENING
Drug Screen and Background Check Required
HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYER
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.
https://recruiting.paylocity.com/recruiting/jobs/Apply/1746518/Health-One-Alliance-LLC/Benefit-Plan-Configuration-Analyst
Job Contact:
Chris Ramsay
7068834378
Time:
Full time
Salary:
Hourly
Category:
Operations
201 W Waugh St
Dalton, GA 30720
7068834378
https://alliantplans.com