Plan Administration Manager

The Plan Administration Manager reports to the Chief Administrative Officer. This role is very collaborative and will require in-depth knowledge of the benefits department workflow and how this impacts other departments. This position oversees the day-to-day operations of Plan Administration, and is responsible for the following duties of these departments:

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Benefit Plan Analysts (5)-assure that all benefit plans are programmed accurately and timely within the claims system.
• Plan Administration/Provider Maintenance Analysts (2), - assure that all provider databases are maintained with demographic information, fee schedules, and network participation. Internal and external provider inquiry resolution.
• Utilization Management Coordinator (1), -Claims appeals are reviewed and responded to in accordance with regulatory guidelines. This position would oversee the Utilization Management process, and assist where necessary.
• Auditor (1)- Oversee the auditing program of claims payments to ensure processing was in accordance with established procedures, plan design, vendor requirements, contract terms and Regulatory guidelines.
• Manage employee development and performance.
• Coordinate and/or assist with special projects at the direction of the CAO.
• Perform other duties as assigned.

GENERAL EXPECTATIONS:

• Present a positive image of Consociate at all times.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a client or coworker.
• Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
• Identify and perform work that has not been specifically assigned, as needed.
• Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
• Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Plan Administration Division.
• Attend required in-service and staff meetings.
• Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups, individuals and employees.
• Adheres to established safety standards and utilizes proper techniques to avoid work-related injuries

SERVICE EXPECTATIONS:

• Greet all people in a prompt and courteous manner. Communicate in a warm and courteous manner, making eye contact and speaking in a tone of voice that matches words.
• Offer and provide assistance whether the request falls within your specific job duties.
• Respond to clients and coworkers requests in a timely manner, returning calls promptly and keeping them informed of delays before they ask.
• Make decisions based on client needs, opinions, or suggestions.
• Take appropriate steps to resolve problems to the client's satisfaction.
• Seek opportunities, provide value-added services, and eliminate tasks that do not serve our client.
• Remain aware of products and services provided by Consociate Dansig.
• Project a positive, professional image when working.

KNOWLEDGE, SKILLS AND ABILITY REQUIREMENTS:

• Bachelor’s degree in health, business or related field or comparable work experience.
• Three (3 ) Years of Management Experience.
• Ability to analyze benefit plans and programming rules to demonstrate a benefit structure within an automated claims processing system.
• Four (4) years’ experience working in a managed care/healthcare environment.
• Healthcare management database experience.
• Knowledge of managed care products.
• Knowledge of provider contracting.
• Knowledge of CPT, HCPCS, ICD9, revenue code and/or DRG coding practices.
• Strong analytical, technical, and problem-solving skills.
• Mini Project Management Skills.
• Ability to maintain production levels and quality goals.
• Must be articulate, possess professional business manner and have excellent organizational, interpersonal and communication skills.
• Ability to understand the systems functionality and business policies.

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Paid training
• Vision insurance