Benefits Analyst Lead

Regal Medical Group•Los Angeles, CA

14d•$30 - $32

About The Position

Provides daily supervision, leadership and coordination in the maintenance of Regal Medical Group’s claims processing system. Supports accuracy of member benefit set up, assignments, claims processing, financial accuracy and data integrity.

Requirements

In depth knowledge of Health Care and benefit options
In depth knowledge of Coding and/or certification as it relates to the association to Health plan benefits
3-5 years of Claims Adjudication experience
A bachelor’s degree from a four-year college or appropriate industry experience and/or certification.
Excellent written and verbal communication skills.
Fundamental management skills of planning, organizing and delegation, ability to mentor, coach and council.
In-depth knowledge, experience and understanding of the managed care industry.
Strong track record of success in management positions, experience in provider organization preferred.
3-5 years of experience in management of Health Care processing systems.

Nice To Haves

Medical group or IPA operations information systems management experience preferred.
Experience with clinical applications preferred.

Responsibilities

Provides daily oversight of benefits
Coordination with IS programming staff to identify components of the benefit data maintenance structure that can be systematically updated.
Develops and Implements data integrity initiatives for all supporting system configuration including fee schedules, provider contracts, benefits, eligibility and any other areas that support the effective operation of internal systems.
Develops standards, policies and procedures to ensure data integrity within the EZCap systems, and distribution of processes to network office as it relates to benefits
Coordinates with Data Management staff to provide standards be followed and performs random audits and work with Decision Support in creating the audit queries.
Communicates and implements programs within focused area of responsibility.
Communicates, monitors and audits processes and procedures necessary to achieve strategic objectives.
Oversees the department goals, prioritizes work load and priorities within benefit team.
Evaluates and communicates needs for staffing and provides input to the selection, employment, and evaluation of all employees in his/her area of direct responsibilities.
Ensure all systems within their area of responsibility are reliable, responsive and support to the needs of the Regal Medical Group network.
Develops and fosters a customer satisfaction focused, service mentality within department to strengthen and build relationships with Heritage Provider Network and other Regal Medical Group regions and departments and communicates a balanced view of Data Management importance in relation to other departments and business functions.
Attends administrative meetings and provides information to staff as appropriate.
Supports initiatives that are identified, communicates and negotiates projects with the users and management.
Ensures appropriate management of information systems staff, providing the timely completion of performance appraisals and corrective counseling, when necessary.
Achieves successful delivery of data management deliverables meeting internal and external client needs
Serves as the primary client liaison for data management benefits issues
Administers and ensures timely completion of all projects, develop work plans and maintains project deadlines
Reviews data management plans for content and structure
Performs all other duties as directed by management.