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 …