Plan Language Coordinator - Oregon

at  Innovative Care Management Inc

Description:
Under the general direction of the Manager, Utilization Management, the Plan Language Coordinator is responsible for maintaining and updating ICM’s plan language library for client Summary of Plan Description (SPD)/benefit books. The Plan Language Coordinator acts as a liaison between ICM and the TPA when communication is needed for benefit or plan language verification and appropriately stores the new guidance. The Plan Language Coordinator acts as a subject matter expert for the benefit books and supports the medical necessity review process by providing plan language interpretation when needed.

WORK EXPERIENCE, QUALIFICATIONS, ADDITIONAL SKILL AND ABILITIES, AND PROFESSIONAL COMPETENCIES:

• Three years’ experience with strong claims processing and analytical experience, (Required)
• 2 years of experience reviewing and interpreting benefit plan books, required. 3 years of experience preferred
• 2 years’ experience in medical billing and collections, preferred
• Experience with self-funded and/or ERISA plans, preferred
• Strong working knowledge of both In and Out of Network claims processing
• Knowledge of medical terminology, CPT and ICD Coding and billing forms (HCFA)
• Strong time management, organization, attention to detail skills/abilities.
• Ability to complete assigned tasks and projects on time and with accuracy.
• Ability to use a computer and quickly learn and master different software platforms as needed to perform assigned tasks and responsibilities.
• Self-motivated with the ability to take initiative and work effectively in both an independent and collaborative business environment.
• Excellent relationship management skills, including non-aggressive assertiveness.
• Demonstrate abilities to problem solve multifaceted and/or emotionally complex situations.
• Ability to engage in abstract thought.
• Ability to successfully navigate conflict and reaching mutually beneficial solutions.
• Strong organizational, task prioritization, and delegation skills.
• Strong focus on patient advocacy and empathy.

EDUCATION, LICENSURE, AND CERTIFICATION REQUIREMENTS:

• High School Diploma or GED, required.
• Two years of college, preferred.

SPECIFIC POSITION REQUIREMENTS & RESPONSIBILITIES:

• Enter or transcribe specific plan language from SPD and/or benefit plan books to appropriate ICM system(s) including benefit limits, coverages, exclusions and definitions
• Communicate with Third Party Administrators (TPA) to ensure that ICM has the most updated plan book, requesting new books when applicable
• Maintain and update list of pending plan book entries
• Maintain SPD and email expiration dates
• Act as liaison between ICM and TPA for complex plan language verification when needed to support the medical necessity review process
• Enter/transcribe specific group language from email communication to appropriate ICM system(s)
• Maintain and store plan books and emailed benefit verification for future use
• Add benefit verification language and plan book information to appropriate ICM system(s)
• Enter benefit and eligibility verification information into appropriate ICM system(s)
• Provide benefit guidance and interpretation to ICM team members as requested
• Serve as plan language representative at monthly ISC meeting
• Provide clarification of plan language in relation to ISC guidance
• Additional duties as assigned

GENERAL ICM EMPLOYEE REQUIREMENTS & RESPONSIBILITIES:

• Establish effective rapport with all employees, company management, customers, clients, TPA partners, members, and physicians.
• Actively maintain ICM’s philosophy of non-adversarial patient advocacy.
• Actively support company and departmental QA/QI initiatives.
• Actively support departmental and corporate strategic plans and ensure successful implementation.
• Comply with all HIPAA compliance rules including Privacy, Security and Breach Notification.
• Follow all guidelines listed under the Code of Conduct in the Employee Handbook.
• Understand and comply with the ICM Compliance program as outlined in the Employee Handbook.
• Demonstrate a clear understanding of and uphold ICM’s mission, purpose, and philosophy.
• Maintain confidentiality of all company and patient-related information.
• Protect patient rights as defined in the Patient’s Bill of Rights.
• Adhere to ethical business practices by striving to perform in a manner that conforms to the highest standards of ethical behavior, integrity, and honesty.
• Promote a safe and efficient working environment by adhering to agency policies and procedures.
• Treat employees, patients, and business partners with respect. Foster teamwork by trusting and supporting each other while encouraging collaboration at all levels of the organization.
• Honor diversity and support cultural awareness through daily work and customer interaction.
• Promote health literacy by communicating in ways that are understandable to ICM clients. Be conscious of the use of plain language while avoiding the use of complex medical terms or jargon when interfacing directly with or writing content for consumers.
  Requirements: