Create and maintain documentation related to products and benefits that will serve as a resource to the company to help interpret and support benefit administration, implementation of new and revised benefits, and product integrity. Support the development and submission of product filings as needed, as well as support the full implementation of product and benefit changes and ensure regulatory and product compliance with all laws in terms of end to end development, implementation through claims adjudication.
- Create and maintain the benefit screens in Facets
- Review all LCD/NCD, Medicare Benefit Policy Manuals and other interventional manuals, as well as Medicaid Provider Manuals to monitor and track changes
- Review and monitor all regulatory changes (mandates), determine products impacted
- Document all changes to benefits for the Benefit Specialist and Manager, Benefits Administration to review, as a result of regulatory changes
- Document all changes to benefits for the Benefit Specialist and Manager, Benefits Administration to review, as a result of CMS or Medicaid changes
- Present changes at BIT, as needed, for operational analysis
- Support the development and submission of amendments needed as a result of benefit changes
- Identify changes needed to member materials as a result of regulatory, CMS or Medicaid changes
- Oversee and track implementation steps necessary as a result of benefit changes
- Support the creation and maintenance of the authorization matrix, in conjunction with the Coding Specialist and Benefit Specialist
- Represent Benefits Administration as a company-wide resource in terms of product and benefit questions, concerns and issues.
- Associates or Bachelors Degree or the equivalent combination of training and experience
- Minimum of 1-3 years in the Healthcare industry, particularly in positions that are familiar with product and/or regulatory compliance
Competencies, Skills, and Attributes:
- Familiarity with CMS regulations, Medicaid regulations, and regulatory compliance preferred.
Working Conditions and Physical Effort:
- Effective collaborative and proven process improvement skills.
- Strong team player
- Strong oral and written communication skills; ability to interact within all levels of the organization.
- A strong working knowledge of Microsoft Office products.
- Demonstrated ability to successfully plan, organize and manage projects
- Detail oriented, excellent proof reading and editing skills
- Strong analytic skills in terms of ability to interpret regulations and assess impact to products.
- Ability to work OT during peak periods. (Non-Exempt Positions)
- Regular and reliable attendance is an essential function of the position.
- Work is normally performed in a typical interior/office work environment.
- No or very limited physical effort required. No or very limited exposure to physical risk.
Boston Medical Center HealthNet Plan - 17 months ago