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Benefit Configuration Specialist / Business Analyst
Ref No.: 17-00251
Location: New York, New York
Position Type:Direct Placement
Start Date: 12/29/2017
Our client, a health care provider located in NYC is looking for a Benefit Configuration Specialist to join their team, as a full time employee (M-F 8:00 AM to 5:00 PM).

The Benefit Configuration Specialist will be responsible for the codification and mapping of the benefits product building, including the development and maintenance of the benefit documentation and service rules required for each benefit category. 

We are looking for a person that is going to act as a subject matter expert in all areas of the medical plan configuration, medical utilization edits, service payment limits and service rules; for the upgrading of the system that generates benefit authorization for members.

Responsibilities:
  • Develops workflows and business processes to ensure timely and accurate system build.
  • Acts as a facilitator to accurately translate product benefit and all aspects of the service rules into a configurable document.
  • Provides business requirements to core configuration for purposes of translating clinical concepts into system configuration requirements.
  • Provides guidance to fellow employees and providers regarding documentation concerns as they relate to coding and billing.
  • Validates the ICD-9-CM / ICD-10-CM codes billed on the medical claim and DRG assignments appropriateness to ensure consistency and efficiency in inpatient claims processing, data collection, and quality reporting for the medical unit; report results, findings and recommendations to the supervisor, and assist with the development of process improvements to maintain data quality.
  • Ensures timely and accurate document preparation and reference materials for team members for future reference of medical benefit configuration setup.
  • Oversee test load and configure business decisions into system.
  • Support quality reviews and testing of all benefit setup prior to implementation and go-live date.
  • Partner with Compliance department to audit setups and configure post go-live.
  • Resolve escalated and complex processing, change requests, issues or questions.
  • Responsible for own work flow assignments and must be able to take the initiative to resolve problems and meet deadlines.
  • Serve as a lead for team regarding any benefit and configuration issues or questions.
Required Education, Training & Professional Experience:
  • 5+ years health care experience as a Business Analyst being responsible for Benefit configuration.
  • 1 year medical coding experience with demonstrated sustained coding quality a plus.
Licensure and/or Certification: Certification as a professional coder (CPC) is a plus.

Position type: Direct hire/Full Time (not remote work allowed).

If you or someone you know has the experience described above, you can contact:

Andrea Diaz
adiaz@knappconsultants.com


*Knapp Consultants is an Equal Opportunity Employer - Minority/Female/Disability/Veteran/Current Unemployment Status. EEO is the Law

About Knapp:
Knapp Consultants Inc., established in 1985, is a leading national recruitment firm headquartered in Rock Tavern, New York with a branch office in Virginia. The firm has an established presence in several major markets throughout the United States as well as specific global markets. 
Our commitment to integrity and quality has earned Knapp a distinguished reputation.  Knapp holds a New York State license, a rigorous and voluntary program. 
Our extensive industry associations give us insight to a broad range of industries and services, enabling our recruiters to best meet your  recruiting needs.
The vision of Knapp Consultants, a Human Resources Company, is to offer superior recruitment, and contract staffing, and Human Resources services to meet the ever-changing needs of our clients.