Providence is calling a Managed Care Benefit Plans Specialist to Providence Health & Services in Mission Hills, CA.
We are seeking a Managed Care Benefit Plans Specialist to provide system support for benefit plans including building and maintaining benefit plan details in managed care and/or benefit/health plan systems. Has a working knowledge of the managed care/benefit/health plan system and its integration with referrals, eligibility and claims adjudication. Responsible for fast, accurate entry of benefit plan information including but not limited to coverage category, employer plan links, adjudication messages, benefit plan limits, Responsible for the day-to-day maintenance of health plan benefit information.
In this position you will have the following responsibilities:
- Actively support and incorporate the mission and core values into daily activities. Treat all others with respect and demonstrate excellence, justice and compassion in daily work and relationships with others.
- Work collaboratively with clients to determine information and data requirements. Evaluate and report on a variety of topics, sometimes complex in nature.
- Provide guidance to customers on way to maximize the return on investment for their applications. Educate clients, and create related documentation as necessary.
- Work with internal teams to develop business decisions. Uses professional knowledge and independent judgment in making decisions or recommending a course of action.
- Demonstrates service excellence and positive interpersonal relationships in dealing with others, including patients/families/members, employees, managers, medical staff, volunteers, and community members, so that productivity and positive relations are maximized.
- Consistently demonstrates and incorporates principles of safety and infection control into daily activities as outlined in Environment of Care, Infection Control, and Exposure Control manuals. Uses protective equipment and takes appropriate precautions whenever there is potential for contact with blood, body fluids and/or chemicals. Maintains knowledge of work-appropriate aspects of environment of care program. Attends Environment of Care skills fair and participates in fire and disaster drills.
- Perform audit and testing of benefit plan system set-up
Required qualifications for this position include:
- Associates' degree or equivalent blend of education and experience.
- 2-3 years functional experience.
- Knowledgeable of ICD and CPT codes.
- Knowledgeable of HMO/POS health insurance plans, benefits and products.
- Skilled in maintaining benefit plans in managed care systems.
- Understands benefit plan details posted on health plan websites.
- Skilled in configuring benefit plans including but not limited to coverage category, coverage limits, coverage exceptions in managed care systems.
- Works with users in identifying and correcting system issues relating to benefit plans
- Working knowledge of managed care systems dictionaries and integration points with eligibility, referrals and claims processing.
- Competent in auditing the accuracy of benefit plan configuration in system.
- Ability to develop test plans relating to benefit plans and test managed care application benefit plans during upgrades.
- Ability to work independently
- Well organized and detail oriented.
- Skilled in working collaboratively, courteously and tactfully with difficult situations and/or people to recognize issues and solve problems.
- Respects confidentiality of all information related to patients, medical staff, employees, and as appropriate other information.
- Able to define and meet their own goals considering organizational mission, quality, budget, customers, financial results.
- Understand customers business needs and workflow
- Builds constructive and effective relationships and can identify others' needs for information and communication. Can adapt communication style to meet needs of others.
- Collaborates with peers to create and maintain documentation.
- Understands and builds test plans. Acts as a resource during testing and upgrades; coordinates with appropriate individuals.
Preferred qualifications for this position include:
- 1-2 years of experience in a managed care or IPA healthcare setting, GE Centricity Business Managed Care application benefit plan maintenance support.
About the department you will serve.
Providence Strategic and Management Services provides a variety of functional and system support services for all eight regions of Providence Health & Services from Alaska to California. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Support Services
Location: California-Mission Hills
Req ID: 151040