Benefit Support Analyst II

Job Summary:

The Benefit Support Analyst II is responsible for reviewing and breaking down complex medical business requirements into configurable requirements and collaborating with the configuration team throughout the end-to-end implementation of new, existing, and modified benefits.

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 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
• Utilize reports to analyze data to assist with issue resolution
• 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
• Participate in the review and update of the SOPs
• Update and maintain the data management tool
• Attend and support internal/external meetings
• Participate in projects as assigned
• Assist in the training and development of new hires and continuous training for peers
• Assist with the Quarterly Code process
• 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 two (2) 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:

• Intermediate computer skills with Microsoft Suite
• Proven understanding of database relationships preferred
• Knowledge in CPT, HCPCS and ICD-CM Codes
• 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
• 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

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:
$55,350.00 - $88,560.00 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:
Salary

Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.