[Hiring] Plan Coding Specialist I @Allied Benefit Systems

Role Description

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.

Qualifications

• High School diploma or equivalent required.
• 1-2 years Healthcare Benefits Experience required.
• 1-2 years Plan Coding experience preferred.
• Proficient in the use of Word and Excel programs.
• Experience with or ability to learn Microsoft Access.
• 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.

Competencies

• Communication
• Customer Focus
• Accountability
• Functional/Technical Job Skills

Physical Demands

• This is an office environment requiring extended sitting and computer work.

Work Environment

• Remote

Benefits

• Competitive Benefit Package including, but not limited to:
• Medical, Dental, Vision, Life and Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• EAP
• Technology Stipend