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Benefit Plan Configuration Auditor

Remote:

Full Remote

Contract:

Full time

Salary:

6 - 75K yearly

Experience:

Senior (5-10 years)

Work from:

United States

Offer summary

Qualifications:

High school diploma or GED required, 3-5+ years in claims adjudication/auditing, Experience in employee benefits administration preferred, Knowledge of medical billing and coding, Strong organizational and communication skills.

Key responsabilities:

Review plan benefits for accuracy
Conduct audits on new implementations and changes
Maintain documentation of audit findings
Ensure compliance with regulatory requirements
Assist in training new audit team members

Virgin Pulse Large https://www.virginpulse.com/

1001 - 5000 Employees

See more Virgin Pulse offers

Job description

Your missions

Overview:

Now is the time to join us!

We’re Personify Health. We’re the first and only personalized health platform company to bring health, wellbeing, and navigation solutions together. Helping businesses optimize investments in their members while empowering people to meaningfully engage with their health. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Responsibilities:

Who are you?

The Plan Building Auditor is responsible for the review of plan benefits for new and existing groups upon implementation, renewal, and changes. The responsibilities of the Plan Build Auditor are to ensure the highest level of quality, in accordance with current guidelines and policies.

In this role you will wear many hats, but your knowledge will be essential in the following:

Perform audits of built plans within the Plan Building department for new implementations, plan changes and plan renewals
Maintain and provide records of plan build audits, including documentation to support findings and any remediation that is deemed necessary from the findings. Audit documentation should be considered holistic and be available to supervisors, upon request.
Assist in developing and implementing internal audit procedures and best practices.
Identify trends and specific plan building weaknesses that may be improved with review training
Understand the translation of benefits from ICD10, HCPCS, CPT, CDT, and other insurance billing codes into plan configurations
Ensure compliance with applicable government regulations, in partnership with internal Compliance partners and experts
Troubleshoot claims errors during audit process and refer escalated issues to departmental supervisor(s).
Other related duties as assigned to meet departmental and Company objectives
Supporting on-boarding and training of new audit team members

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Qualifications:

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

High school diploma or general education degree (GED).
3-5+ years of experience in claims adjudication and/or auditing required
Previous experience in employee benefits administration with experience with self-funded health plans preferred
Previous experience in QicLink, HEALTHpac and/or GIAS systems preferred
Highly organized, detailed-oriented, and deadline-driven.
Ability to work independently with limited required direction and guidance.
Strong listening skills
Ability to identify gaps in logic.
Strong working knowledge of medical billing and coding and/or medical claims processing
Ability to write, read and interpret documents and instructions, short correspondence, and memos. 
Ability to draft and maintain documentation
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
Strong communications skills to effectively interact with various teams.

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $44,000 to $75,000. Note that salary may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

#WeAreHiring #PersonifyHealth

Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to talent@virginpulse.com. All of our legitimate openings can be found on the Personify Health Career Site.