Benefit Support Analyst III (config Experience Required)

Benefit Support Analyst III

This position supports TRICARE Prime Demo by CareSource Military & Veterans, which aims to enhance healthcare access and prioritize the unique needs of the military community. 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.

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:

• Military affiliation or TRICARE experience is preferred.
• 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