Product Development Benefit Analyst - Product Development

Job Description

POSITION SUMMARY

Responsible for the product development and governance department in at least one of the following areas: Medicare bid, Qualified Health Plan (QHP) filings, operational benefit implementation, OR benefit vendor management and oversight.

PRIMARY ACCOUNTABILITIES

1. Support the maintenance of benefit sources of truth.
2. Obtain required data and information in support of the product development and implementation decision making process.
3. Support operational business processes and foster operational excellence across the organization as it relates to benefit alignment.
4. Evaluate the impact of new and changing laws affecting health plan benefits and effectively communicate those impacts to leadership.
5. Participate in efforts to evaluate benefit coverage, payment and other health plan criteria to ensure appropriate benefit administration.
6. Participate in projects that impact health plan benefits by supporting all affected internal functional areas, external vendors and stakeholders to ensure that business needs and implementation time frames are met.
7. Assist in creating accurate benefit plan documents (i.e., EOC, ANOC, SBCs, Schedule of Benefits, etc.) and internal benefit reference documents (Benefit Interpretations, SupportPoint, etc.) working with key functional areas to ensure all products and benefit definitions are approved, designed and implemented correctly.
8. Assist in the collection, consolidation, and validation of required information and data to maintain data integrity as it relates to product development.
9. Support leadership in performing benefit gap analysis, identifying current state, future state, operational needs, and best practices.
10. Will be considered a Subject Matter Expert (SME) in at least one of the following areas:
    1. Medicare bid, Qualified Health Plan (QHP) filings, operational benefit implementation, OR benefit vendor management and oversight.

Qualifications:

MINIMUM QUALIFICATIONS

• Education: Bachelor's Degree in business, healthcare, or related field.
• Licensure: None required.
• Certification: PAHM Certification (will be required during first year of employment).
• Work Experience: 2 years healthcare experience.
• Work Experience in lieu of Education: Additional 4 years of healthcare experience.
• Knowledge/Skills/Abilities:
  
  • Knowledge of Medicare, Commercial and Individual coverage/guidelines as it relates to health insurance.
  • Ability to read, analyze and interpret complex regulatory documents.
  • Detailed level of understanding of insurance and associated terminology.
  • Consistently demonstrate strong attention to detail.
  • Possess strong computer abilities with emphasis on Microsoft Office - Excel, Outlook, PowerPoint, SharePoint, Teams, Word.
  • Highly organized, motivated, responsible self-starter, with excellent time management, communication, analytical, research and problem solving skills.

PREFERRED QUALIFICATIONS

• Education: No additional
• Licensure: No additional
• Certification: No additional
• Work Experience: No additional
• Knowledge/Skills/Abilities:
  
  • Possess an understanding of Health First Health Plans and Health First Insurance product offerings.
  • Knowledge of CPT, ICD-10 and HCPCS coding systems and ability to interpret codes as they relate to plan benefits.
  • Knowledge of Medicare bid and/or QHP filing process.
  • Experience with AMISYS Advance or similar claims system.

PHYSICAL REQUIREMENTS

• Majority of time involves sitting or standing; occasional walking, bending, stooping
• Long periods of computer time or at workstation
• Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
• May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.
• Workspace may vary from open to confined; on site or remote.
• May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.