Medical Plan Configuration Analyst - Remote

Allied Benefit Systems•Chicago, IL

3d•$48,000 - $50,000•Remote

About The Position

The Plan Building Analyst analyzes plan documents to accurately build and maintain group set-up in the Qiclink System. This role involves accurately coding self-funded and fully insured groups, updating coding for all plan changes, and setting up and maintaining HRA processing plans. The analyst will also maintain applicable programs to ensure the appropriate sharing of prescription accumulators, audit the accuracy of all tasks completed, and create and maintain group documentation for correct claim processing. Additionally, the role requires utilizing Excel spreadsheets and Access databases, assisting in automation by coding benefits that require no intervention, and manually adding accumulators for new groups when necessary. Coordination with plan documentation and account management staff is crucial for accurately coding difficult benefit levels. The analyst will also analyze and correct problems identified through referrals, test and provide documentation for system upgrades, and adhere to all applicable privacy and security laws, including HIPAA and HITECH. Responding to benefit-related questions and performing other assigned duties are also part of the role.

Requirements

Bachelor’s degree or equivalent work experience required
Must have 3 or more years of comprehensive experience with the building and coding of medical, dental and vision plans
Must have a minimum of 3 years’ experience using the Qiclink system
Must have strong analytical skills and knowledge of computer systems and CPT and ICD-9 coding terminology required
Proficient in the use of Excel and Word programs
Experience with or ability to learn Microsoft Access
Strong written and verbal communication skills required
Reliable internet service is essential for staying connected and productive. The internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload.

Responsibilities

Accurately code self-funded and fully insured groups based on the plan document
Accurately update coding for all plan changes
Set up and maintain HRA processing plans
Maintain applicable programs to ensure the appropriate sharing of prescription accumulators
Audit the accuracy of all tasks completed
Create and maintain group documentation to ensure the correct processing of claims when manual intervention is required
Utilize excel spreadsheets and access databases in order to efficiently complete all tasks
Assist in automation by coding benefits that require no intervention
Manually add accumulators for new groups when necessary
Coordinate with plan documentation and account management staff to ensure difficult, detailed benefit levels can be accurately coded
Analyze and take appropriate action to correct any problems identified through referrals from claims, plan tester and customer service
Test and provide documentation for each system upgrade
Learn, adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto
Attend continuing education classes as required, including but not limited to HIPAA training
Respond timely and accurately to all benefit related questions that come to Plan Building
Other duties as assigned