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Consociate Health · 3 weeks ago

Benefit Documentation Coordinator

United States

Full-time

Remote

New Grad, Entry Level

Consociate Health is a leading Third-Party Administrator, dedicated to making healthcare more accessible and affordable through innovative solutions. The Benefit Documentation Coordinator will be responsible for creating and maintaining client documentation within the Account Management Division, ensuring compliance and accuracy in all documentation processes.

Employee BenefitsHealth CareInsurance

Responsibilities

Maintaining tracking sheet of renewal dates ("Renewal Date CLIENT LIST"), regularly distributed to Reinsurance and Accounting depts

Creating/maintaining individual groups' Contract Specs files

Creating new, renewal, revised, and term specs using the following as source docs: reinsurance proposals and applications, Implementation Guide, other plan's renewal proposals for COBRA admin, Admin Services Agreement, collected emails from and consultations with Sales/AE/Accounting/Eligibility/Vendor Relations, Consociate Consolidated Contact List, term notices/Agreements, rate notification changes from Vendors

Review/evaluation of renewal information based on anticipated plan changes, vendor changes, reinsurance, or reinsurer changes

Creating/maintaining specs projects in Monday.com

Tracking approvals/requested revisions until final distribution

Distributing on Monday.com and maintaining h-drive Specs repository files

Specs template maintenance/revisions based on compliance needs, plan designs, Vendor PEPM/PPPM requirements on invoices or vendor claims, consultations with Reinsurance/Ops/Accounting/Vendor Relations departments and Account Executives

Creating/maintaining group's SPD files in Account Management folder, which includes all SOBs, source docs, drafts, special requests

Maintaining/revising templates used for SOBs (separate 1, 2, 3, and 4 tier templates)

Creating SPD in Phia's PDM (Plan Doc Management system) using the following as source docs: specs, SBCs, Implementation Guide, ID cards, SOBs, plan build notes, collected emails about singular plan issues, previous group documents including Personnel Manual, SPD, SBCs

Making corrections to standard template errors

Revising initial creation with required language for additional items like domestic partner/civil union partner, BJC HealthSolutions groups, QBE transplant policy, Sentinel, KISx, UM/UR Vendor-specific precert requirements with group-specific alterations to those, Specialty Rx vendors language including Smith Connect 360, ScriptSourcing, Cerpass/Focus, Sharx, PaydHealth, etc., adding/revising/reformatting SOB(s)

Revising and reformatting from reviews by Plan Build, broker, group, AE

Auditing all source docs against each other and against SPD for consistency of plan build items, network arrangements, ERISA status, grandfathered vs. non-grandfathered compliance requirements, etc

Converting/combining final signature in final versions and distributing through email (this triggers placement on Sharepoint by Client Service and sending SPD to Reinsurance Carrier/MGU

Placing on member portals

PDM maintenance and requests/evaluations of proposed template changes for compliance/new regulations, Consociate-specific changes, and general error reviews

Creating/maintaining individual group's Amendment files in Account Management folder

Maintaining tracking sheet of amendments requested/sent for review/completion

Creating, revising, consulting on plan amendments using the following as source docs: emails from AE/broker/Eligibility/Plan Build, SPDs, previous amendments, special language required by specific vendors for Specialty Rx, UM/UR changes, PBM changes, etc

Monitoring legislative/compliance changes that require plan changes across book of business (COVID, NSA, Gender-Affirming Care, removal of outdated language, etc.)

Creating SOBs when needed for plan amendments (when group adds a plan, changes coinsurance levels, adds or subtracts a tier of coverage, or requests an updated SOB)

Tracking approvals/requested revisions until final distribution

Distributing through email and placing on member portals (this triggers placement on Sharepoint by Client Service and sending to Reinsurance Carrier/MGU

Loading approved SBCs, SPDs, Amendments into appropriate portals, separating by appropriate divisions when needed, using correct dates for start/stop display depending on type of doc loaded

Annual audit for limiting historical docs shown on portals

Maintaining h-drive Plan Docs repository files, including showing historical vs. current

Adding/changing Employer and Broker Admin Rights, ensuring HIPPA web agreements are signed and saved

Creating/maintaining group's annual SBC files in Account Management folder, which includes all SBCs in word and pdf, and their source docs

Maintaining/revising templates used for SBCs (separate 1, 2, 3, and 4 tier templates), including any template revisions required by Dept of HHS, CMS, DOL

Updating standard language across templates for compliance changes, major plan design formats

Creating/revising individual SBCs for new groups, standard annual changes, plan changes in conjunction with Amendments

Creating/maintaining AE's annual PCORI files in Account Management folder, which includes all reports and letters for each of their groups

Creating AE-specific tracking sheets for their group's PCORI rate based on group's renewal date falling before or on/after 10/1 of each successive year

Creating 2/each AE-specific informational letters (rate determination, filing procedure, links to govt's PCORI filing specific website updated annually) addressed to broker/group, that accompany the PCORI reporting itself, with separate letters depending on group's specific PCORI rate based on group's renewal date falling before or on/after 10/1 of each successive year

Running all PCORI reports from Access, reformatting to PDF, relabeling when necessary

Sending via email all PCORI reports and informational letters to all group and broker contacts, cc'ing AE

Sending via email advisory letters to all groups and broker contacts, cc'ing AE, for groups whose effective date with Consociate pre-dates the dates required for that year's PCORI fee filing

Responding to emails from groups and brokers who have questions about the PCORI reporting, letters, or advisory notices

Oversee monthly fixed cost entry, including adding/creating new Transaction Type codes and maintaining How-To-Guide

Monthly Data entry of Over-Spec amounts from monthly reports

Maintaining files of monthly Sales Journal from accounting, including revised invoicing details

Running reporting as requested

Maintenance of Consociate Consolidated Contact Sheet using the following as source docs: emails from AE/broker/Eligibility/Vendor Relations, Contract Specs, Implementation Guides

Evaluation of plan design proposals on existing groups

Interpretation of/considerations for plan document language

Reformatting/editing word docs, converting to pdf and visa versa, editing pdf's

Running reports from Access for specific group requests

Maintaining files for quarterly Walmart Health Virtual utilization reporting from IT's SFTP folder

Qualification

Documentation ManagementCompliance KnowledgeInsurance Industry UnderstandingData EntryProject ManagementCommunication SkillsOrganizational SkillsTeamworkActive Listening