Benefits & Coding Administrator

Site: Mass General Brigham Health Plan Holding Company, Inc.

 

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

 

 

Job Summary

This is a remote role that can be done from most US states.

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.

 

Qualifications

Qualifications:

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

• Associate’s Degree in health science administration, business, or healthcare-related field.

• At least 3 years of experience in valuing the impact of benefit coverage decisions with the support of analytics preferred.

• At least 3 years of experience in a related role required

Preferred/Desired:

• Bachelor’s Degree.

• Knowledge of and experience with Medicare Advantage plan coverage.

• Knowledge of and experience with Dual Eligible-Medicare/Medicaid/DSNIP plan coverage.

• Knowledge of and experience with Medicaid health insurance products.

• Knowledge of Commercial health insurance products.

• Knowledge of and experience with QNXT claims processing system.

• Knowledge of and experience with medical claim analysis.

• Knowledge of healthinsurance contracts and benefits, managed care products, Medicare products, HMO, PPO or health insurance benefit design.

• Working knowledge of healthcare regulation at a State and Federal level.

SKILLS/COMPETENCIES

• Excellent technical skills