Benefits Support Analyst

ALTA is supporting a contract opportunity working remote located anywhere in the United States

The Benefit Support Analyst III is responsible for reviewing and breaking down complex medical business requirements into configurable requirements and working with configuration and other partners in helping to develop the strategic direction of member benefits across all states and product lines.

What leader is looking for: Someone who can break down benefits from a policy booklet, COC, SOB, regulations, etc. not someone who understands HR benefits, that is different. This would need to be someone who has requirements experience, to understand if there is a benefit for acupuncture, they have to ask, is there a limit, what is the cost share, what procedures may be involved, what place of service, what providers, etc. If they have config experience or claims processing experience, that is a plus as they then understand the level of detail.

ALTA IT Services is a wholly owned subsidiary of System One, a leading provider of specialized workforce solutions and integrated services. ALTA is an established leader in IT Staffing and Services, for both government and commercial enterprises across the United States, specializing in Program & Project Management, Application Development, Cybersecurity, Data & Advanced Analytics, and Agile Transformation Services.

Essential Functions:

• Create and maintain benefit grids with annual and ad hoc changes

• Create, maintain, review, and analyze configuration templates to validate benefit requirements and regulations are accurate; collaborate with policy and markets to confirm and resolve conflicts

• Perform peer review of configuration templates and provide documentation of results within the defined SLA guidelines; identify and implement opportunities for process improvement

• Communicate effectively with various internal departments to enhance cross-functional awareness, promote process improvement, and identify root cause resolution of issues

• Participate in the annual benefit change process with Product Management and Benefit Analysts as appropriate per market

• Create and utilize reports to analyze data to assist with issue resolution and impact analysis

• Adhere to defined SLAs while also accommodating urgent requests

• Incorporate critical thinking skills, discretion, and independent judgement into the analysis process to determine the best course of action for each issue/task

• Create and maintain SOPs and supporting process flows

• Provide guidance and mentorship to teammates/peers

• Update and maintain the data management tool

• Lead and facilitate cross functional or project meetings as assigned

• Assist in the training and development of new hires and continuous training for peers

• Manage the Quarterly Code Process across multiple teams for all LOB’s

• Lead and/or participate in projects as assigned

• Act as Back up to Team Lead, Triage Analyst and all BA functions as needed

• Perform any other job-related instructions as requested

  Education and Experience:

• Bachelor's degree in a related field or equivalent years of relevant work experience is required

• Minimum of five (5) years of medical benefit plan design and/or configuration experience is required

• Configuration experience (Facets or equivalent system) preferred

• Managed Care or healthcare experience is preferred

  Competencies, Knowledge and Skills:

• Advanced computer skills with Microsoft Suite

• Proven understanding of database relationships preferred

• Advanced knowledge of CPT, HCPCs and ICD-CM Codes preferred

• Working knowledge of other claims related reference data, such as types of bill, revenue codes, places of service

• Proven understanding of the upstream and downstream impacts of code level benefit details

• Problem solving skills

• Communication skills, both written and verbal

• Ability to work independently and within a team environment

• Attention to detail

• Knowledge of Medicare, Medicaid or Marketplace medical insurance benefits preferred

• Claims processing knowledge preferred

• Ability to work in a fast-paced environment managing multiple priorities

• Ability to build and maintain strong working relationships with cross-functional teams

• Knowledge of regulatory requirements of Outpatient Prospective Payment System (OPPS) and other payer requirements preferred

• Ability to break down complex benefit requirements

• Excellent organizational skills and ability to meet deadlines

• Strong interpersonal skills and high level of professionalism

• Facets or other systems knowledge/training preferred

• Decision making/problem solving skills

  Licensure and Certification:

• AAPC Coding designation preferred

System One, and its subsidiaries including Joulé, ALTA IT Services, CM Access, TPGS, and MOUNTAIN, LTD., are leaders in delivering workforce solutions and integrated services across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible full-time employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.