Benefits/Configuration Matrix Specialist - Remote

Overview

The Benefits/Configuration Matrix Specialist is responsible for maintaining the accuracy and timeliness of the Benefit Matrix tables within the EZ-Cap system for all databases. This role ensures that benefits, financial responsibilities, and other configurations align with contracts, regulations, and operational needs.

In Short

• Maintain and update Benefit Matrix tables in EZ-Cap.
• Ensure timely updates to all tables as required by changes in contracts or member benefits.
• Configure benefit categories and adjudication rules for accurate claims processing.
• Interpret contract and benefit changes for implementation in the EZ-Cap database.
• Import, process, and export health plan benefit data efficiently.
• Collaborate with various departments to align system configurations with member benefits.
• Identify opportunities to improve and automate processes.
• Stay informed about industry trends and health plan benefit changes.
• Review monthly audit results for accurate benefit configuration.
• Resolve issues and coordinate with other departments for resolutions.

Requirements

• Minimum of three years’ experience in claims processing and/or auditing.
• Internal or external audit experience is preferred.
• Ability to work effectively with minimal supervision.
• Proficient in medical terminology, CPT, ICD-9, revenue codes, and HCPCS codes.
• Strong verbal and written communication skills.
• Excellent organizational and interpersonal skills.
• Experience with EZ-Cap claims modules and functionalities.

Benefits

• Temp-to-perm position with a benefit plan offered.