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):
PLAN BUILDER RESPONSIBILITIES:
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.
EEO & ADA