Health Plan Benefits Specialist

Provide daily support in the maintenance of Regal Medical Group's claims processing system. Supports accuracy of member benefit set up, assignments, claims processing, financial accuracy and data integrity.

Essential Duties and Responsibilities include the following:

• Interpret and configure data for Health Plan benefits and apply correct co-pays and coverage.

• Communicates and implements programs within focused area of responsibility.

• Communicates, monitors and audits processes and procedures necessary to achieve strategic objectives.

• Ensure all systems within their area of responsibility are reliable, responsive and support to the needs of the Regal Medical Group network.

• Develops and fosters a customer satisfaction focused, service mentality within department to strengthen and build relationships with Heritage Provider Network and other Regal Medical Group regions and departments and communicates a balanced view of Data Management importance in relation to other departments and business functions.

• Achieves successful delivery of data management deliverables meeting internal and external client needs

• Administers and ensures timely completion of all projects

• Reviews data management plans for content and structure

• Performs other duties as necessary

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Paid Time Off (PTO)
• Company celebrations
• Employee Assistance Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Education and/or Experience:

• 3-5 years of HMO Claims Adjudication experience (Professional & Institutional)

• In depth knowledge of Health Care and HMO Benefit products and/or certification as it relates to the association to Health plan benefits

• In depth knowledge of Coding (CPT,HCPCS,ICD9,DRG)

• In-depth knowledge, experience and understanding of the managed care industry.

• Medical group or IPA preferred.

• 3-5 years of experience in management of Health Care processing systems.

• Excellent written and verbal communication skills.

• A bachelor's degree from a four-year college or appropriate industry experience and/or certification.