Healthplan Benefits Analyst Lead

Job Description

Job Description

Position Summary:

Provides daily supervision, leadership and coordination in the maintenance of Regal Medical Group’s claims processing system. Supports accuracy of member benefit set up, assignments, claims processing, financial accuracy and data integrity. 

Education and / or Experience:

• In depth knowledge of Health Care and benefit options
• In depth knowledge of Coding and/or certification as it relates to the association to Health plan benefits
• 3-5 years of Claims Adjudication experience
• A bachelor’s degree from a four-year college or appropriate industry experience and/or certification.
• Excellent written and verbal communication skills.
• Fundamental management skills of planning, organizing and delegation, ability to mentor, coach and council.
• In-depth knowledge, experience and understanding of the managed care industry.
• Strong track record of success in management positions, experience in provider organization preferred.
• Medical group or IPA operations information systems management experience preferred.
• 3-5 years of experience in management of Health Care processing systems.
• Experience with clinical applications preferred.

Essential Duties and Responsibilities include the following:

• Provides daily oversight of benefits
• Coordination with IS programming staff to identify components of the benefit data maintenance structure that can be systematically updated.
• Develops and Implements data integrity initiatives for all supporting system configuration including fee schedules, provider contracts, benefits, eligibility and any other areas that support the effective operation of internal systems.
• Develops standards, policies and procedures to ensure data integrity within the EZCap systems, and distribution of processes to network office as it relates to benefits
• Coordinates with Data Management staff to provide standards be followed and performs random audits and work with Decision Support in creating the audit queries.
• Communicates and implements programs within focused area of responsibility.
• Communicates, monitors and audits processes and procedures necessary to achieve strategic objectives.
• Oversees the department goals, prioritizes work load and priorities within benefit team.
• Evaluates and communicates needs for staffing and provides input to the selection, employment, and evaluation of all employees in his/her area of direct responsibilities.
• Ensure all systems within their area of responsibility are reliable, responsive and support to the needs of the Regal Medical Group network.
• Develops and fosters a customer satisfaction focused, service mentality within department to strengthen and build relationships with Heritage Provider Network and other Regal Medical Group regions and departments and communicates a balanced view of Data Management importance in relation to other departments and business functions.
• Attends administrative meetings and provides information to staff as appropriate.
• Supports initiatives that are identified, communicates and negotiates projects with the users and management.
• Ensures appropriate management of information systems staff, providing the timely completion of performance appraisals and corrective counseling, when necessary.
• Achieves successful delivery of data management deliverables meeting internal and external client needs
• Serves as the primary client liaison for data management benefits issues
• Administers and ensures timely completion of all projects, develop work plans and maintains project deadlines
• Reviews data management plans for content and structure
• Performs all other duties as directed by management.

The pay range for this position at commencement of employment is expected to be between $30 - $32 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Company Description

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.