Benefits and Coding Administrator

2 days ago

Somerville, MA, United States Mass General Brigham Health Plan Full time

This role supports the accurate and effective implementation of benefits across all products. It's primarily responsible for benefit configuration and ensuring the configuration aligns with business requirements. Acting as a subject matter expert, the incumbent will work on projects, committees, and workgroups to contribute to business discussions and developments.
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 regarding benefit coverage and configuration, drawing on claims experience, knowledge of regulatory requirements, industry standards regarding coding and billing, and payer benchmarking for ad hoc and system-wide decisions.
-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.
-Contribute to benefit property development or modification in the integrated care administrative transaction system by coordinating business requirements with configuration requirements.

Education

  • Associate's degree required


Experience

  • At least 3-5 years of experience in a related role required
  • At least 3-5 years of experience in valuing the impact of benefit coverage decisions with the support of analytics required

Knowledge, Skills, and Abilities

  • Strong knowledge of ICD-10, CPT, and HCPCS coding systems, as well as insurance verification and authorization processes.
  • Familiarity with healthcare revenue cycle management, including claims processing, denial management, and reimbursement methodologies.
  • Excellent analytical, organizational, and problem-solving skills, with a strong attention to detail.
  • Effective communication and interpersonal skills, with the ability to work collaboratively with various teams.
  • Ability to stay current with changes in coding standards, payer requirements, and healthcare regulations.

Working Conditions

  • This is a remote role that can be done from most US states
  • This role is 40 hours/week with five 8-hour days, with a typical schedule of 8:30 am to 4:30 pm
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

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