Benefit Configuration Analyst

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Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

The Benefit Configuration Analyst is responsible for ensuring plan design within the claims adjudication systems is accurately built to adjudicate claims to match contractual/health plan design rules. This work is critical to TPA operations, claims payment determinations, data reporting and analysis. This individual must possess the capacity to interpret client/Plan intent and build plans, fee schedules, provider network designs and complex provider contracts within the various platforms utilized to administrator health plans. He/she must be capable of communicating Plan rules with IT professionals who archive and report on claims experience. The Group Health Plan Benefit Configuration Analyst must possess a wide spectrum of group health benefits subject matter expertise and must have the wherewithal to juggle competing priorities including ad hoc requests and regulatory demands on a tight schedule.

Job Duties

• Analyze and understand TPA business requirements to effectively and creatively implement Medical/Dental/Vision/FSA benefit plan designs developing necessary claims rules within claims adjudication system(s).
• Serve as resource and liaison to leadership and IT regarding Group Health/claims related concerns. Research in conjunction with Group Health supervisors.
• Understand the intricacies of plan member eligibility, provider networks and benefits to meet the needs of varied clients.
• Investigate and troubleshoot system issues reported by Group Health staff, engaging Populytics IT when necessary.
  
• Facilitate system upgrades through coordination with IT system application analyst(s). Ensure complete testing of applications for all departments within Group Health and support function areas of Populytics.
• Possess the capacity to understand the intricacies of complex claims applications and the judgment and skill required to set up custom Plans.
• Regularly interface with Populytics IT team to review and resolve system issues with the appropriate vendor.
• Coordinate all facets of implementation of new plan designs including modifications during Open Enrollment. Actively participate with implementation and client services team. Maintain documentation of all plan designs and ongoing updates.
• Present process improvement recommendations to Group Health management aimed at claims processing efficiency and increased productivity. Work with Group Health Trainer to drive curriculum development and training sessions.
• Interface with Provider Maintenance and Provider Services teams to appropriately vet provider network designs and build contracts accordingly.

• Bachelor's Degree or
• 5 years equivalent experience in health plan administration.
• 5 years in healthcare benefits administration focused on plan building, claims operations and claims system hierarchy designs as well as claims processing experience, knowledge of TPA business model and ERISA Qualified Plans.
• Strong interpersonal and communication skills. High degree of professional judgment and ability to interact with all levels and among all disciplines. Strong problem-solving skills, confidence to accept responsibility for claims department productivity-tied system design.

• Bachelor's Degree

Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

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