Benefit Configuration Analyst Ii

Let’s do great things, together
Founded in Oregon in 1955, ODS, now Moda, is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.
Job Summary:
Responsible for Benefit Configuration and administration for all new and renewing Medical or Dental groups, with a focus plans of moderate to high complexity, including table update projects, achieving the highest possible auto-adjudication rates, while at the same time maintaining excellent quality. Maintain Enterprise Benefit Tracker (EBT) notes groups as needed to provide additional clarity to internal and external users regarding benefit specifics. Analyzes system solutions, defines and builds benefit designs, and maintains configuration within the systems
This is a hybrid position based in Portland, Oregon. Please fill out an application on our company page, linked below, to be considered for this position:https://j.brt.mv/jb.do?reqGK=27724209&refresh=true
​​Benefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Required Skills, Experience & Education:

1. Bachelor’s degree or equivalent work experience.
2. Higher problem-solving skills, approaching resolutions on their own by testing updates made to configuration in system test environments.
3. Must have strong understanding of various governmental regulations for benefits and claims that pertain to ACA, Medicare Advantage, or Medicaid plans.
4. Serve as a mentor to level 1 staff, by assisting with training, answering questions, and being available to as a resource.
5. Proven ability to handle multiple lines of business or complex and unique plans.
6. Proven facilitation and conflict resolution skills.
7. Ability to analyze and recognize potential business impacts for all affected departments with regard to benefit and or contract changes and to offer probable solutions or alternatives.
8. PC proficient with good working knowledge of Microsoft Word, Excel, and Access (SQL).
9. Demonstrated proficiency in knowledge and configuration experience in Medical Claims, Clinical Editing and Utilization Management.
10. Ability to communicate effectively, both orally and in writing with users, systems personnel, vendors, clients and management.
11. Ability to correctly analyze and interpret contracts, coupled with state and federal laws and limitations, and to convert into Benefit Configuration.
12. Ability to audit product configuration with a high degree of accuracy, and within established timelines.
13. Demonstrated ability to meet or exceed quality expectations on a consistent basis.
14. Ability to plan, organize and prioritize task assignments to ensure established guidelines, timelines and quality goals are met.
15. Ability to document business processes.
16. Ability to train new staff on Benefit Configuration for assigned work.
17. Ability to come into work on time and on a daily basis and work additional hours as needed.
18. Ability to work independently, with minimal supervision.
19. Maintain confidentiality and project a professional business image.

Primary Functions: (Functions may vary depending on level)

• Meets all requirements of a level 1 Benefit Configuration Analyst.
• Knowledge of standard medical plan configuration as well as complex ASO groups, using the information provided to determine the most effective and efficient configuration to achieve the highest possible quality and auto-adjudication.
• Creates and maintains Facets benefit components and configures products for commercial standard and complex groups, spanning multiple product lines.
• Participates in meetings (both Implementation and other) representing Benefit Configuration to fully understand plan benefits and validate Facets capabilities.
• Facilitates meetings for decision making around Moda’s handling of specific procedure and/or diagnosis codes.
• Ensures Benefit Configuration turnaround times are met for all work assigned.
• Answers inquiries from various internal departments regarding contract and product set-up issues on assigned business.
• Performs quality audits on Benefit Configuration at the direction of department management.
• Performs quality assurance testing on test claims to validate Benefit Configuration will meet the needs of the Claims departments.
• Evaluates and resolves Benefit Configuration questions via claims and email inquiries.
• Communicates product updates and changes to the company via e-mail or EBT updates.
• Assists with department projects and reports at the direction of department management
• Interprets benefit information from the group application and or contract language in order to create a product within corporate turnaround time standards.
• Demonstrates problem solving skills, by thinking “outside the box” to identify the most efficient use of the system’s capability from a corporate perspective.
• Identifies situations where Benefit Configuration alone cannot fully meet the plan’s requirements. Works with departmental management, and cross functionally, to identify the Workflow configuration and associated business processes needed.
• Is proficient and understands how medical coding and claims processing works in conjunction with the clinical editing functionality within the system.
• Documents departmental policies and business processes as assigned by department management.
• Deals tactfully and respectfully with all departments, knowing that each department brings a different view and be able to understand the differences of opinions.
• Facilitates project from beginning to end, this will include meetings, documentation and configuration of benefits.
• Participate in special projects and committees.
• Supports quality and process improvement initiatives.
• Performs other duties as assigned.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.
For more information regarding accommodations please direct your questions to HRAdmin@modahealth.com.