Spec, plan builder

Company Name:
Location: MD-Annapolis
Other Locations:
As a part of the Tenet and Catholic Health Initiatives family, Conifer Health Solutions is a leading healthcare business process management services provider working to improve operational performance for more than 600 clients so they can support financial improvement, enhance the patient experience, and drive value-based performance. Through our revenue cycle management, patient communications, and value-based care solutions, we empower healthcare decision makers--hospitals, health systems, physicians, self-insured employers, and payers--to better connect every point of care and wellness management. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
Conifer Health Solutions is currently hiring for aPlan Builder Specialist, Annapolis, MD
The Plan Builder Specialist is responsible for building benefit schedules in the LuminX platform. The employee works closely with managers and client executives to implement plan design health benefits. They ensure that system configurations meet internal and legislative guidelines. Familiar with standard concepts, practices, and procedures within the LuminX platform and meets defined goals.
The Plan Builder Specialist assists in the implementation process, plan building and maintenance thereof, as well as the audit processes along with various Ad Hoc requests.
The Plan Builder Specialist must be able to solve problems efficiently, manage their time well and handle multiple projects simultaneously. The employee is required to work longer than normal hours when implementing systems enhancements and updates.
Maintain Plan Design on the claims system
Respond to Examiners' Plan Design issues and inquiries within 24-hours
Resolution of Plan Design issues and inquiries within 5 business days
Assure Plan Policies and Office procedures are being followed
Assist examiners in areas of weaknesses if found
Alert examiner of proper procedure code set up
Perform audit on new and revised plan
Maintain BUILDING mailbox
Review SPD and Amendments to provide guidance on discrepancies
Build service codes for new plans/schedule updates
Assist Examiners in Plan interpretation
Supply examiners in Service Profile for assigned groups
Report Plan design inconsistencies and system issues to Manager
Review Luminx Manual to determine other functions available to assist in processing
Maintain and update Auto Release Parameters
Implentation of Web to LumiX of Eligibility
Assist in implementations
Attend Staff Meetings (bi-weekly)
Provide Manager of updated list of persistent and common issues and complaints; Provide recommendations
Review of SPD and Plan Amendments
Review Luminx Manual
Review legislative guidelines and provides recommendations
Assist in testing of new LuminX system releases
Provide recommendations on Plan Design and Benefit Structures to TPA Managers
Assist in New Group Implementation and Plan Building
Assist in the Open Enrollment processes as needed
Make recommendations to increase accuracy & client satisfaction
Monitor weekly newsletters/publications to increase knowledge
Generate LuminX and Web reports as requested by management & clients
Assist in the development and Maintenance of TPA Policies and Procedures
Ad Hoc request
Must have:
Minimum 5 years Senior Claims Examiner background
Claims Quality Assurance Experience
Training Experience
Email (Outlook, Zimbra)
Microsoft Word, Microsoft Excel, Microsoft Access, Advanced computer skills
Ability to pass position test
Excellent Verbal and Written Communication skills
Ability to prioritize work and successfully meet deadlines
Ability to communicate effectively with other members of the department
Ability to lead
2-year degree in related field
5 years experience in related field
Speaking: Expressing or exchanging ideas by means of the spoken word. This includes activities in which the reviewer must accurately and concisely convey detailed instructions or abstract concepts to clients, other employees, and audiences.
Hearing: Ability to receive, process, understand and act upon complex materials through spoken language
Lifting: Moving moderately weighted objects from one position to another
Fingering: Working primarily with fingers and the whole hand or arm, as in handling, typing, etc.

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