Coordinator, Health Plan Benefits
2 weeks ago
The Coordinator, Benefits is responsible for supporting the Benefits team through the interpretation of health plan benefits to effectively respond to member, provider, and internal inquires. Reporting to the Supervisor, Health Plan Benefits, the Coordinator will be responsible for benefit coverage verification and interpretation.
Duties and Responsibilities
• Accurately respond to phone and email inquiries from members, providers, and internal departments regarding benefit coverage verification, copayments, coinsurance, deductible, out-of-pocket limits, and financial responsibility
• Escalate inquiries that require the Supervisor or Team Lead review and response
• Complete the initial setup for all new benefit options by creating new Option Masters, entering out-of-pocket and deductible limits
• Download and maintain a file for all health plan Evidence of Coverage (EOC), benefits listings, and benefits summaries
• Support project team with development of system enhancements and new processes to optimize productivity and workflow
• Additional tasks as directed by Team leadership
Minimum Job Requirements
• High school graduate or GED equivalent
• Minimum of two years’ experience with claims or authorization processing in an IPA or health plan environment, or equivalent experience
• Knowledge of ICD and CPT/HCPS coding
• Experience in managed care environment preferred
• Proficiency in Excel a must
Skill and Abilities
• Strong verbal and written communication skills
• Detail oriented and the ability to work independently
• Strong customer service skills with the ability to respond to a high volume of calls and/or email inquiries
• Ability to multitask in a fast-paced environment
• Technologically intermediate or advanced skills in MS product, i.e., Word, Excel
• Excellent organizational skills
• Heavy data entry and computer use
• Able to stay focused on the telephone despite noise and other distractions
• EZ-CAP® knowledge, including Benefit Matrix and/or Financial Responsibility setup, a plus
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