Benefits & Coding Administrator

Mass General Brigham; Somerville (MA); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking a Benefits & Coding Administrator II to support the implementation of benefits across all products. This remote role involves evaluating benefit configurations, collaborating with various teams, and ensuring accurate benefit information. Ideal candidates will have a CPC certification and experience in healthcare-related fields. Join us to contribute to innovative member-centered care in a diverse environment.

Benefits

Competitive salaries

Flexible work options

Career growth opportunities

Qualifications

• At least 3 years of experience in assessing benefit coverage decisions.
• Certified Professional Coder (CPC) certification or experience with coding.

Responsibilities

• Evaluate benefit configuration and ensure alignment with business requirements.
• Support maintenance and enhancement of benefit information.
• Lead coding and coverage discussions on operational work.

Skills

Communication

Organizational Skills

Analytical Skills

Education

Associate’s Degree in health science administration

Bachelor’s Degree

Tools

Microsoft Office Suite

QNXT

Job description

Site: Mass General Brigham Health Plan Holding Company, Inc.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

This is a remote role that can be done from most US states.

Reporting to the Manager, Benefits Administration, the Benefits & Coding Administrator II works with the Benefits Administration Team to support the accurate and effective implementation of benefits across all products.

ESSENTIAL FUNCTIONS

1. Evaluate benefit configuration in collaboration with IT Configuration and Claims staff, ensuring that benefit configuration aligns with the approved business requirements and plan materials.
2. Contribute to business discussions regarding benefit coverage and configuration, drawing on claims experience, knowledge of regulatory requirements, industry standards regarding coding and billing, and payer benchmarking for ad hoc and system-wide decisions.
3. Support the maintenance and enhancement of benefit information in KCII (Knowledge Center II).
4. Represent Benefits Administration as a subject matter expert on corporate projects, committees, or workgroups.
5. Provide technical business summaries on selected benefit topics to support the development and maintenance of benefits for specific programs and plans.
6. Research and benchmark new codes released quarterly, lead the code load process, and present at the Benefit & Coding Committee; submit business requirements to IT Configuration.
7. Lead coding and coverage discussions on operational work and projects, collaborating with teams such as Product Management, Compliance, Provider Reimbursement, Provider Payment Integrity, IT Configuration, Clinical, Pharmacy, Customer Service, and Claims.
8. Contribute to benefit property development or modification in the QNXT system by coordinating business and configuration requirements.
9. Monitor the accuracy of benefit information in member materials, working with Product Management and stakeholders.
10. Maintain benefit information accuracy in internal communication channels via the Benefit Clarification process and Knowledge Center.
11. Enhance KCII to improve communication of benefit coverage, collaborating with Customer Service.
12. Maintain and update the Code Search Lookup feature quarterly.
13. Evaluate the Benefit Clarification Library for updates to QNXT and KCII.
14. Participate in Benefit & Coding Committee meetings and other relevant meetings.
15. Hold self and others accountable to meet commitments.
16. Build strong customer relationships and deliver solutions that meet expectations, maintaining effective communication internally and externally.

Qualifications

Required:

• Certified Professional Coder (CPC) certification or experience with ICD-9, ICD-10, CPT, HCPCS codes, and claims billing requirements.
• Associate’s Degree in health science administration, business, or healthcare-related field.
• At least 3 years of experience in assessing benefit coverage decisions with analytics support.
• At least 3 years of experience in a related role.

Preferred/Desired:

• Bachelor’s Degree.
• Experience with Medicare Advantage, Dual Eligible-Medicare/Medicaid/DSNIP, Medicaid, or Commercial health insurance products.
• Knowledge of QNXT claims processing system and medical claim analysis.
• Understanding of health insurance contracts, benefits, managed care, Medicare, HMO, PPO, and health insurance benefit design.
• Knowledge of healthcare regulations at State and Federal levels.

Skills/Competencies

• Proficient in Microsoft Office Suite (Word, Excel, SharePoint).
• Excellent written and oral communication skills, including technical writing.
• Ability to prioritize work under tight deadlines.
• Demonstrates organizational core values: Accountability, Service Excellence, Quality Care, Diversity, and Relationships.
• Respect for diversity and cultural differences.
• Self-aware, receptive to feedback, and disciplined in self-improvement.
• Responsible for high-quality work and ownership.

About Us

Mass General Brigham Health Plan is a leading healthcare organization committed to innovation and member-centered care within a diverse and inclusive environment. We offer competitive salaries, benefits, flexible work options, and career growth opportunities.

Additional Job Details

Working Conditions: Remote role from most US states

Work Location: 399 Revolution Drive

Scheduled Weekly Hours: 40

Employee Type: Regular

Work Shift: Day (United States of America)

EEO Statement

Mass General Brigham is an Equal Opportunity Employer. We provide accommodations for applicants with disabilities. For accommodations, contact Human Resources at (857)-282-7642.

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