Benefits Configuration Coordinator

6 days ago

Orange, California, United States All Care To You Full time $60,000 - $90,000 per year

About Us

All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients.  ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees.  We also offer paid holiday, sick time, and vacation time as well as a 401k plan.  Additional employee paid coverage options available.

Position purpose

The Benefits Configuration Coordinator will provide high-quality benefits administration support to All Care to You. This role will focus on the configuration of member's benefits and members out- of-pocket (MOOP). 

Duties and Responsibilities

  • Manage benefits across multiple lines of business (LOBs), ensure accurate setup and maintenance of member benefits, coverage limits, deductibles, copayments, coinsurance, and maximum out-of-pocket (MOOP)
  • Verify member maximum out-of-pocket (MOOP) accumulations against claims and provide MOOP claims reports to health plans
  • Conduct regular audits to ensure accuracy, completeness, and compliance
  • Respond to benefit inquiries from members, providers, health plans, and/or health plan auditors
  • Support internal departments (e.g., Claims, Care Management, Customer Service, Compliance) by providing benefit-related information and contacting health plans as needed
  • Develop, coordinate, and document policies, procedures, and projects that support effective benefits administration
  • Implement and monitor data integrity initiatives related to member benefits, MOOP, and other benefit administration processes
  • Communicate, monitor, and audit operational processes to align with organizational goals and regulatory requirements
  • Provide training and daily support to team members on benefit administration procedures and best practices
  • Ensure compliance with all company policies, procedures, and regulatory requirements.
  • Perform other duties as assigned

Qualifications

  • 2-3 years of healthcare system administration experience
  • Knowledge of healthcare plans and benefits administration processes for Commercial, Medicare, Covered California and Medi-Cal
  • Experience with CPT Codes, ICD-10 Codes and Modifiers
  • Preferred: Experience with EZ-CAP and SQL
  • Must be able to work 8 - 5 PM Pacific Standard Time.
  • Proficiency with Outlook, Microsoft Teams, Zoom, Microsoft Office (Word and Excel) and Adobe
  • Experience developing maintaining policies and procedures
  • Detail oriented and highly organized
  • Strong ability to multi-task, project management, and work in a fast-paced environment
  • Strong ability in problem-solving
  • Attention to detail and accuracy
  • Ability to self-manage, strong time management skills
  • Ability to work in an extremely confidential environment
  • Strong written and verbal communication skills
  • Must work well under pressure and deadlines

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