• Benefit Specialist, Membership Accounting

    Kaiser Permanente Rockville, MD 20851

    Job #1837964046

  • The Benefits Specialist supports the Sr. Manager, Benefit Administration in the development of benefit documentation, administrative processes and other relevant materials. Participates in cross-functional efforts related to the clarification, interpretation, and documentation of benefit administration processes and medical policy development. Partnerships with Medical Group and Health Plan representatives to ensure consistent interpretation of benefit rules and policies. Serves as a liaison with the legal department to clarify and document benefit or contractual language and interpretations. Contributes to the management and maintenance of documentation used to communicate with regulators or regulatory bodies.

    Essential Functions:- Maintains current and in-depth knowledge of how benefits are and can be administered throughout the various KPMAS' systems and departments. Serves as a point of contact to facilitate the resolution of escalated benefit-related inquiries from across the Mid-Atlantic region.- Responds to customized product documentation requests by Sr. Manager, Benefit Administration for product managers, sales representatives, account managers, & other marketing, sales, & business development team members.- Supports the development of training materials & the delivery of training sessions for key stakeholders throughout the organization to communicate benefit clarifications, interpretations, & decisions.- Provides revisions to current products, & relevant changes in KP internal systems, regulatory requirements, & benefit administration policy & procedure changes.- Maintains database of all benefit packages offered as well as an exception tracking system. Develops process of tracking benefits no longer offered. Develops & produces reports that will aid in creating a Quality process for benefit design & offerings.- Ensures that all benefit designs are accurately documented in sufficient detail so as to be entered into systems, allow for smooth administration & provide clarity to members & internal stakeholders.- Participates & supports Medical Benefit Policy Committee meetings & Benefit Policy & Administration Committee (BPAC) meetings with documentation on research or assessment of industry standards, Medicare guideline or other relevant materials for rendering decisions on medical policies or benefits.- Ensures that all benefit designs & interpretations are accurately documented in sufficient detail so as to be entered into systems, for smooth administration & clarity to users.- Serves as a resource for resolution of benefit & contractual clarification issues. Familiar with ICD 9, CPT & other benefit classification/coding tools to ensure appropriate medical definition & benefit rules.- Attends product &/or legal meetings as applicable to craft recommendations for benefit decisions.- Ensures that all relevant stakeholders are included & communicated with when researching & resolving issues. Ensures that there is follow-up on implementation of recommendations.- Presents reports, analyses & recommendations to all appropriate stakeholders. Designs metrics & reports to accurately reflect the work of the unit.- Supports alignment of benefits with pricing tools & system configuration. Works with vendors & internal stakeholders to ensure accurate configuration/validation of benefit variables.- Works closely with the Marketing, Pricing, & Contracts teams to drive benefit designs & strategies consistent with the overall Product Marketing & MSBD strategy.- Facilitates an environment that is customer service focused (both internally & externally). - Participates in responding to RFP's.

    Basic Qualifications:Experience- Minimum three (3) years of experience in managed care, HMO operations, or other area relevant to making new healthcare services within a membership environment required.- Experience in adult education, innovative training methodology and evaluation techniques required.Education- Bachelor's degree or advance degree in business, healthcare related fields, OR four (4) years of experience in a directly related field.- High School Diploma or General Education Development (GED) required.License, Certification, Registration- N/A

    Additional Requirements:- Strong customer and market orientation, as well as broad knowledge of HMO products and healthcare operations required.- Excellent written and oral communications skills required.- Working knowledge of Federal HMO Laws & Regulations; OPM/FEHB Regulations; Maryland & Virginia HMO Laws & Regulations; Federal TEFRA, COBRA, and Medicare Laws & Regulations; and Maryland COBRA Laws & Regulations is required.- Exhibits an ability to focus on details and proactively recognize potential benefit administration and product documentation issues before they occur required.- Demonstrated strong organizational, operational, problem solving, organizational, planning, communication and interpersonal skills required.- Demonstrated ability to work independently with limited supervision as well as the ability to work in a team environment required.

    Preferred Qualifications:- Health care, benefits, and/or insurance experience preferred.


    TITLE: Benefit Specialist, Membership Accounting

    LOCATION: Rockville, Maryland

    REQNUMBER: 987828

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.