The Benefit Policy and Product Analyst is part of our Payment Integrity/Claims team and works with our Payment Policy and Fee Reimbursement Analysts to validate and test configuration changes made by our claims vendor. This will be done to ensure proper systems configuration has been implemented which will help overall integrity of our claim’s payment activities. The Benefit Policy and Product Analyst will work to review and maintain existing product configuration and integrity as well as to help bring new products and benefits to market accurately.
The Benefit Policy and Product Analyst will help to ensure that benefits are well defined according to contracts and all Federal and State Mandates. They will ensure that all benefits can be configured in all systems. The Benefit Policy and Product Analyst will help to ensure that the benefit coding definitions are consistent across the organization and well documented. The Benefit Policy and Product Analyst will clearly understand the products and healthcare benefit services offered to our customers as well as understanding provider impacts.
What you'll be doing
- Provides expert knowledge, impact analysis and recommendations related to configuration design and understands impacts of benefit policy data / provider contract data
- Problem solver who provides coding and design advice to appropriate internal teams as part of any product or benefit implementation, provider contract or claim coding activities as well as oversight of our claim’s vendor
- Creates and maintain required documentation as appropriate for consistency as well as for training purposes
- Act as part of an overall team to ensure that existing system configuration is accurate. This will be for any new products or benefits as well as part of a targeted benefit review process
- Analyzes new and existing benefit configuration documents for feasibility, and regulatory compliance
- Develops and executes processes to analyze, design, configure, existing benefit coding and QA detailed benefit designs, and aids all departments on benefit coding issues
- Develops, documents and executes test plans for configuration testing and validate accuracy of data loaded
- Works as part of the overall Payment Integrity team to ensure all aspects of payment accuracy are met according to all State and Federal mandates as well as individual provider contract requirements
- Bachelor's degree, or equivalent combination of education, training, and experience.
- 4 + years of experience reviewing benefit policies, medical claims and claims configuration.
- Solid Medicare, Medicaid experience
- Solid understanding of payment policy