Senior Benefits Implementation Manager
2 weeks ago
We are an award-winning, not-for-profit health maintenance organization committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.
Our StoryFounded over 35 years ago, Jefferson Health Plans continually develops new ways to encourage better health outcomes and has received national recognition for our innovations in managed care.
Our Benefits- Competitive Compensation Packages including 401(k) Savings Plan with Company Match and Profit Sharing
- Flextime and Work-at-Home Options
- Benefits & Wellness Program including generous Time Off
- Impact on the communities we service
Working under minimal supervision responsible for direction, coordination, development, evaluation and compliance of member benefits for all Jefferson Health Plans lines of business. Uses in depth knowledge of medical coding, reimbursement, clinical operations, and standard benefits for public programs to ensure accurate and efficient implementation of benefit plans.
Responsibilities:- Primary subject matter expert in the interpretation of new and existing member benefits for all lines of business
- Works with Jefferson Health Plans compliance area to ensure products are being implemented according to existing and new regulations by line of business and industry standards.
- Analyzes explanation of coverage documents to lead multi-disciplinary group in determining best approach for loading benefits offered including member cost share and out-of-pocket maximums
- Leads definition of code sets used in benefits configuration and provider reimbursement
- Interprets minimum regulatory requirements for prior authorizations to be used in benefits configuration
- Collects and analyzes data to assess and resolve operational obstacles to benefits design optimization
- Serves as JHP's expert on benefit related legislation
- Maintains documentation necessary for systems analysts to configure benefits
- Develops explanatory information for other departments to better understand benefits configuration across products
- Is a critical participant in the creation test scripts, including regression testing cases, to validate system configuration against source documentation.
- Cultivates collaborative and effective cross-functional relationships with key stakeholders including sales, marketing, operations, compliance, health care management and finance to ensure effective development and deployment of products across the organization
- Leads the Benefit Administration Committee
- Leads interdepartmental teams organized to ensure the effective management of Diagnoses and Service Codes implementation efforts, including clinical classing, age/gender edits and modifier assignments.
- Maintains documentation necessary for systems analysts to maintain code sets within systems
- Responsible for identifying and obtaining diagnosis and service codes on a quarterly basis
- Holds oversight responsibility for the Clinical Editing software
- Bachelor's Degree required and 5 years' experience in insurance industry in areas of Benefits Administration, Health Care Management or related field. RN and/or certified coder preferred.
- Estimated salary range $120,000 - $180,000 per year, depending on qualifications and experience.
Must be a resident of PA or the nearby states of DE or NJ.
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