Plan Coding Specialist I

POSITION SUMMARY

Analyze plan documents to accurately code and maintain group set-up in the Qiclink System.

ESSENTIAL FUNCTIONS

• Accurately code self-funded and fully insured groups based on the plan document.
• Accurately update coding for all plan changes.
• Set up and maintain HRA processing plans.
• Maintain applicable programs to ensure the appropriate sharing of prescription accumulators.
• Audit the accuracy of all tasks completed
• Create and maintain group documentation to ensure the correct processing of claims when manual intervention is required.
• Utilize excel spreadsheets and access databases in order to efficiently complete all tasks.
• Assist in automation by coding benefits that require no intervention.
• Manually add accumulators for new groups when necessary.
• Coordinate with plan documentation and account management staff to ensure difficult, detailed benefit levels can be accurately coded.
• Analyze and take appropriate action to correct any problems identified through referrals from claims, plan tester and customer service.
• Test and provide documentation for each system upgrade.
• Learn, adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.
• Attend continuing education classes as required, including but not limited to HIPAA training.
• Respond timely and accurately to all benefit related questions that come to Plan Building.
• Other duties as assigned.

EDUCATION

• High School diploma or equivalent required.

EXPERIENCE AND SKILLS

• 1-2 years Healthcare Benefits Experience required.
• 1-2 years Plan Coding experience preferred.
• Applicants must be proficient in the use of the Word and Excel programs.
• Applicant should be proficient in the use of the Excel and Word programs, have experience with or ability to learn Microsoft Access and be able to communicate effectively both orally and by email. All applicants must have strong analytical skills and knowledge of computer systems and CPT and ICD-9 coding terminology. Continuing education in all areas affecting group health and welfare plans is required.

COMPETENCIES

• Communication
• Customer Focus
• Accountability
• Functional/Technical Job Skills

PHYSICAL DEMANDS

• This is an office environment requiring extended sitting and computer work.

WORK ENVIRONMENT

• Remote

Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.

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