Strategic Plan Benefits Specialist

hace 2 días


Barrio de Guadalupe del Mezquitillo, Guanajuato, México Scalepex A tiempo completo

We are seeking a highly organized and detail-driven Strategic Plan Benefits Specialist to join our team at Scalepex.

About Scalepex

Scalepex is a dynamic services firm specializing in providing nearshore solutions. We empower organizations to thrive in a rapidly evolving digital landscape by connecting them with top-tier professionals from around the world.

Job Summary

The Strategic Plan Benefits Specialist will be responsible for building and maintaining plan benefits for new and existing groups upon implementation, renewal, and changes. This role requires strong working knowledge of medical billing and coding, as well as excellent communication skills to effectively interact with various teams.

Main Responsibilities

  • Support Implementation and Account Management teams by consolidating information during new client implementation and/or renewal to ensure the accuracy of benefits.
  • Translate benefits from ICD10, HCPCS, CPT, CDT, and other insurance billing codes.
  • Configure benefits in claims processing systems.
  • Generate benefits summaries, at a group level, for internal and external use in supporting member and provider understanding of available benefits.
  • Ensure compliance with applicable government regulations.
  • Audit plans build work of other teammates.
  • Process Group terminations, as needed.
  • Correspond with account managers, account coordinators, claims department, and other technical areas.
  • Troubleshoot claims errors and refer escalated issues to team lead or manager.
  • Support on-boarding and training of new team members.

Requirements

  • 2+ years of experience in healthcare field, claims or benefits strongly preferred.
  • Experience with Self-funded health plans strongly preferred.
  • Strong working knowledge of medical billing and coding and/or medical claims processing.
  • High school diploma or general education degree (GED).
  • Highly organized, detailed-oriented, and deadline-driven.
  • Ability to read and interpret documents and instructions, short correspondence, and memos.
  • Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
  • Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
  • Ability to deal with problems involving several concrete variables in standardized situations.
  • Strong communications skills to effectively interact with various teams.

Earnings Potential

We estimate that this role will have an earnings potential of $65,000 - $90,000 per year, depending on experience.



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