Plan Building & Testing Coordinator (Troy, MI)

BeneSys, Inc. - Troy, MI (30+ days ago)3.4

Job Title: Plan Building & Testing Coordinator

SUMMARY: Review SPD’s and other documentation, along with working with the Plan Managers to determine Fund benefits. Configure, maintain and test those Plan Benefits in the Claim Processing system.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following (other duties may be assigned):

Interpretation of Summary Plan Descriptions

Familiarity with Healthcare regulations, not limited to but including HIPAA and PPACA.

Set up the benefits for Medical, Vision, Dental, Flex, and Short Term Disability Plans.

Add/Delete/Update all codes required for claims processing in the Eldorado system

Maintain the Eldorado Category Definitions

Identify methods to improve auto-adjudication

Create the Benefit outlines for New Funds

Make corrections to the Benefit outlines when a Fund has a plan change

Test the benefits for new Funds for Medical, Vision, and Dental, documenting the scenarios that passed and failed

Document and track Plan change requests on the Plan Build log

Investigate and track claims processing and system issues

Testing of Eldorado releases (3 times of years) and the interim patches

Troubleshooting of claims processing and system issues

Review accuracy of converted history and accumulators when new Groups are implemented

Maintain relationship with Eldorado

Maintain pricing contracts and fee schedules in Eldorado

Other duties as assigned

QUALIFICATIONS: Background in medical claims processing, knowledge of medical terminology; able to understand and apply benefits as defined by the Summary Plan Descriptions. Familiarity with CPT, HCPCS, ADA and ICD coding. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE: - Post high school education or prior medical system configuration related work experience preferred.