General Summary:
The Plan Administration Manager reports to the Chief Administrative Officer. This role is very collaborative and will require in-depth knowledge of the benefits department workflow and how this impacts other departments. This position oversees the day-to-day operations of Plan Administration, and is responsible for the following duties of these departments:
Principal Duties and Responsibilities:
- Benefit Plan Analysts (5)-assure that all benefit plans are programmed accurately and timely within the claims system.
- Plan Administration/Provider Maintenance Analysts (2), – assure that all provider databases are maintained with demographic information, fee schedules, and network. participation. Internal and external provider inquiry resolution.
- Utilization Management Coordinator (1), -Claims appeals are reviewed and responded to in accordance with regulatory guidelines. This position would oversee the Utilization Management process, and assist where necessary.
- Auditor (1)- Oversee the auditing program of claims payments to ensure processing was in accordance with established procedures, plan design, vendor requirements, contract terms and Regulatory guidelines.
- Manage employee development and performance.
- Coordinate and/or assist with special projects at the direction of the CAO.
- Perform other duties as assigned.
General Expectations:
- Present a positive image of Consociate at all times.
- Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a client or coworker.
- Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
- Identify and perform work that has not been specifically assigned, as needed.
- Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
- Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Plan Administration Division.
- Attend required in-service and staff meetings.
- Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups, individuals and employees.
- Adheres to established safety standards and utilizes proper techniques to avoid work-related injuries.
Service Expectations
- Greet all people in a prompt and courteous manner. Communicate in a warm and courteous manner, making eye contact and speaking in a tone of voice that matches words.
- Offer and provide assistance whether the request falls within your specific job duties.
- Respond to clients and coworkers requests in a timely manner, returning calls promptly and keeping them informed of delays before they ask.
- Make decisions based on client needs, opinions, or suggestions.
- Take appropriate steps to resolve problems to the client’s satisfaction..
- Seek opportunities, provide value-added services, and eliminate tasks that do not serve our client.
- Remain aware of products and services provided by Consociate Dansig.
- Project a positive, professional image when working.
Knowledge, Skills and Ability Requirements:
- Bachelor’s degree in health, business or related field or comparable work experience.
- Three (3+) Years of Management Experience.
- Ability to analyze benefit plans and programming rules to demonstrate a benefit structure within an automated claims processing system.
- Four (4) years’ experience working in a managed care/healthcare environment.
- Healthcare management database experience.
- Knowledge of managed care products.
- Knowledge of provider contracting.
- Knowledge of CPT, HCPCS, ICD9, revenue code and/or DRG coding practices.
- Strong analytical, technical, and problem-solving skills.
- Mini Project Management Skills
- Ability to maintain production levels and quality goals.
- Must be articulate, possess professional business manner and have excellent organizational, interpersonal and communication skills.
- Ability to understand the systems functionality and business policies.
Physical and Mental Abilities:
- Ability to perform sedentary work for extended periods of time.
- Ability to utilize personal computer, telephone system, and communicate with a variety of clients.
Reporting Structure/Supervision:
- Reports to the Chief Administration Officer.
Working Conditions:
- Work may be performed onsite or offsite.
- Overtime as needed may be requested.
- Travel as needed may be requested.
