Benefits Configuration Analyst

📋 Description

• • Configure, test, and maintain health insurance benefit plans within company systems to ensure accuracy, functionality, and compliance with federal and state regulations.
• • Review and update medical coding systems including CPT, HCPCS, and ICD-10 codes to align with current benefit designs and reimbursement policies.
• • Conduct regular audits of benefit configurations to identify and resolve discrepancies, inconsistencies, or errors in plan setup and coding.
• • Collaborate with IT teams to integrate benefit configurations into technology platforms, ensuring seamless data flow and system functionality.
• • Validate and reconcile medical billing codes across claims processing systems, procedure code master files, and claim adjudication reports.
• • Perform research on coding methodologies and reimbursement rules to resolve discrepancies and support accurate claim processing.
• • Maintain comprehensive documentation for all benefit configuration processes, changes, and procedures to ensure audit readiness and knowledge continuity.
• • Ensure compliance with CMS (Centers for Medicare & Medicaid Services) guidelines and other insurance governance agency requirements.
• • Analyze clinical documents and prepare coding support for services to align with benefit plan structures and regulatory standards.
• • Administer reviews of professional billing systems and evaluate claims work queues to identify and correct coding errors.
• • Test policy and coding changes using reports, claim adjudication tools, and other testing software to validate system behavior.
• • Manage and resolve entry errors in coding databases and maintain up-to-date knowledge of procedural codes and reimbursement methodologies.
• • Prepare reports on coding compliance, configuration accuracy, and regulatory adherence for internal stakeholders and leadership.
• • Participate in training initiatives related to new benefit designs, regulatory updates, or system changes driven by CMS or other agencies.
• • Work independently with strategic thinking to prioritize tasks, manage multiple deadlines, and ensure timely resolution of configuration issues.
• • Maintain strong written and oral communication skills to collaborate effectively with clinical, non-clinical, IT, and compliance teams.
• • Perform duties in a standard office environment with prolonged computer use and occasional travel to offsite meetings.