Plan Building Specialist

hace 1 semana


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

About the Role:

The Plan Building Specialist will play a critical role in the build and maintenance of plan benefits for new and existing groups upon implementation, renewal, and changes. This position requires a strong working knowledge of medical billing and coding, as well as experience with Self-funded health plans.

Key Responsibilities:

• Consolidate 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 the 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.



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