Plan Coding Specialist I

Allied Benefit Systems•Chicago, IL

7d•Remote

About The Position

POSITION SUMMARY Analyze plan documents to accurately code and maintain group set-up in the Qiclink System. ESSENTIAL FUNCTIONS 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. EDUCATION High School diploma or equivalent required. EXPERIENCE AND SKILLS 1-2 years Healthcare Benefits Experience required. 1-2 years Plan Coding experience preferred. Applicants must be proficient in the use of the Word and Excel programs. Applicant should be proficient in the use of the Excel and Word programs, have experience with or ability to learn Microsoft Access and be able to communicate effectively both orally and by email. All applicants must have strong analytical skills and knowledge of computer systems and CPT and ICD-9 coding terminology. Continuing education in all areas affecting group health and welfare plans is required.

Requirements

High School diploma or equivalent required.
1-2 years Healthcare Benefits Experience required.
Applicants must be proficient in the use of the Word and Excel programs.
Applicant should be proficient in the use of the Excel and Word programs, have experience with or ability to learn Microsoft Access and be able to communicate effectively both orally and by email.
All applicants must have strong analytical skills and knowledge of computer systems and CPT and ICD-9 coding terminology.
Continuing education in all areas affecting group health and welfare plans is required.

Nice To Haves

1-2 years Plan Coding experience preferred.

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.