Benefits Coordinator at LSMA Management Inc

San Bernardino, California, United States -

Full Time

Start Date

Immediate

Expiry Date

08 Jun, 26

Salary

29.0

Posted On

11 Mar, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Benefit Structures, Data Entry, Auditing, Problem-Solving, Cross-functional Communication, Prioritization, Written Communication, Verbal Communication, HIPAA Compliance, Spreadsheet Competence, Claims Adjudication, Benefit Interpretation

Industry

Health and Human Services

Description

Description JOB SUMMARY The Benefits Coordinator is responsible for setting up, maintaining, and auditing benefit plans within EZ-CAP to ensure accurate claims processing and compliance. This role translates contract benefit language into system rules, resolves discrepancies impacting claims adjudication, and supports monthly insurance file loads. The position requires strong attention to detail, problem-solving skills, and close collaboration with Eligibility, Claims, IT, and other internal teams. Requirements MINIMUM & PREFERRED QUALIFICATIONS Education/Training Minimum: High school diploma or equivalent. Preferred: Associate’s degree or coursework in Healthcare Administration, Business, or related field. Experience Minimum: 1+ years of healthcare administration or managed care benefits experience. Preferred: Experience in an MSO, IPA, or health plan; familiarity with benefits interpretation systems (e.g. EZ-CAP). Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position. Skills, Knowledge & Abilities · Understanding benefit structures such as co-pays, coverage limits, visit caps, and exclusions. · General knowledge of Medi-Cal, Medicare, and commercial plan benefits. · Ability to read and interpret benefit information from contracts and plan documents. · Strong accuracy and attention to detail in data entry and documentation. · Ability to identify discrepancies and perform basic benefit audits. · Effective problem-solving and cross-functional communication skills. · Ability to prioritize workload and meet deadlines. · Professional communication skills, both written and verbal. · Ability to maintain confidentiality and follow HIPAA compliance. · Competence using spreadsheets and tracking tools for benefit updates. PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. The position requires extended periods of sitting while working on a computer and using a telephone or headset, along with routine movement such as walking, standing, and bending. The role may also involve occasionally lifting items weighing up to 15-20 pounds. During peak workloads or audit periods, extended work hours may be necessary. To perform essential job functions effectively, the employee must maintain standard visual capabilities, including close and distance vision, color and peripheral vision, depth perception, and ability to adjust focus.

Responsibilities

The Benefits Coordinator is responsible for setting up, maintaining, and auditing benefit plans within EZ-CAP to ensure accurate claims processing and compliance. This role involves translating contract benefit language into system rules and resolving discrepancies impacting claims adjudication.