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(Contract) Benefit Analyst (HRBK Benefit Coder)

(Contract) Benefit Analyst (HRBK Benefit Coder)

# Positions 
2
Location 
US-Home Office/ Remote
Category 
Information Technology - All Openings
Travel Requirements 
0-20%

More information about this job

Overview

This is a remote contract position.

 

Benfit Analyst / Benefit Coder role is accountable for performing quality testing on benefit coding completed within the NPS benefit file, as well as to perform extensive NPS benefit file coding and support duties.  This position will review NAEGs, Certs and Riders, and other benefit related documentation in order to build benefit coding requirements and test matrices, run test claims using tools such as NPS Electronic Error Correction (EEC), clarify requirements with internal and external sources, document and report quality results, make coding changes to the benefit file, and ensure that a high quality benefit code is moved into the system. Communicates with NASCO customers and Team leads on status of assignments in the performance of day to day testing.

Responsibilities

Read benefit requirements documentation per Plan specifics
Interpret benefit requirements documentation
Create/update benefit coding in HRBK per requirements
If appropriate, minimally test change before sending to testing for review
Update source / tracking systems as required by Plan and NASCO
Proactively communicate status to team leader

 

  • Reads customer documentation, such as a NAEGs, to clarify business coding requirements for benefit coding
  • Builds coding grids for the benefit coder
  • Builds unit test plans and schedules 
  • Enters data into NPS table and GENO tables utilizing input from customer submitted CSRs
  • Enters coding into the NPS Benefit File utilizing input from customer submitted CSRs or Benefit Analyst submitted instructions
  • Performs product validation activities including test planning, test development, issue/defect triage and test execution by performing a variety of tests on the NPS code to ensure claims process according to specifications or to determine cause of claim failure using EEC or other tools
  • Communicates with Plan customers and team leaders to validate testing desired outcomes
  • Analyzes quality problems as related to customer assigned problem logs
  • Builds and Runs Test Claims from subscriber information on NPS, working those claims to ensure that they process through the system, and obtaining the results from the claim processes
  • Builds Test membership in membership system in order to run test claims

Qualifications

5+ years Benefit Coding experience in HRBK is required