Personify Health ยท 1 day ago
Benefit Plan Configuration Auditor
United States
Full-time
Remote
Mid Level
$44K/yr - $75K/yr
3+ years exp
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Responsibilities
Perform audits of built plans within the Plan Building department for new implementations, plan changes and plan renewals
Maintain and provide records of plan build audits, including documentation to support findings and any remediation that is deemed necessary from the findings. Audit documentation should be considered holistic and be available to supervisors, upon request.
Assist in developing and implementing internal audit procedures and best practices.
Identify trends and specific plan building weaknesses that may be improved with review training
Understand the translation of benefits from ICD10, HCPCS, CPT, CDT, and other insurance billing codes into plan configurations
Ensure compliance with applicable government regulations, in partnership with internal Compliance partners and experts
Troubleshoot claims errors during audit process and refer escalated issues to departmental supervisor(s).
Other related duties as assigned to meet departmental and Company objectives
Supporting on-boarding and training of new audit team members
Qualification
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Required
High school diploma or general education degree (GED).
3-5+ years of experience in claims adjudication and/or auditing required
Highly organized, detailed-oriented, and deadline-driven.
Ability to work independently with limited required direction and guidance.
Strong listening skills
Ability to identify gaps in logic.
Strong working knowledge of medical billing and coding and/or medical claims processing
Ability to write, read and interpret documents and instructions, short correspondence, and memos.
Ability to draft and maintain documentation
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
Strong communications skills to effectively interact with various teams.
Preferred
Previous experience in employee benefits administration with experience with self-funded health plans preferred
Previous experience in QicLink, HEALTHpac and/or GIAS systems preferred
Benefits
Health, dental, vision, mental health and other benefits
Company
Personify Health
Personify Health is a software that provides health plan administration, comprehensive health navigation, and holistic well-being solutions.
1,001-5,000 employees
Funding
Current Stage
Late StageRecent News
2024-11-15
2024-11-01
2024-11-01
Company data provided by crunchbase
