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CareersPlan Builder/Auditor

Current Job Openings

Plan Builder/Auditor

Posting Date: 09/11/2019
Closing Date: Until Filled

Reports to: Plan Installation Manager
Non-Exempt

Responsibilities

 

Looking to join a company with an amazing culture, visionary Leadership team, and ample opportunities to make a difference?

If so, keep reading!

TML Health is looking to add a Plan Builder/Auditor to our team! The selected candidate will be responsible for the maintenance of plan benefit set up and code direction utilizing plan installation documentation and selection tools. Ensures accuracy of plan set up using quality check out tool and testing processes. Advises staff on system capabilities regarding benefit design and responds to Plan Building referrals. Is knowledgeable of the relationship between Plan Building and other claim and eligibility programs.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Reviews plan/benefit design documentation and to create implementation documentation on Medical, Dental and Vision plans.
  • Performs testing and auditing of Medical, Dental and Vision benefit plan designs
  • Completes Dental plan coding
  • Reviews future-plan designs for feasibility of set-up.
  • Demonstrates ability to identify specific plan/system problems/inefficiencies which may compromise accurate set-up and initiates workable solutions.
  • Researches and responds to inquiries from various departments on plan design impacting claims adjudication
  • Actively contributes with project decision making for functional responsibilities
  • Runs reports and preforms analysis to find coding inconstancies and recommend corrections in plan set up


Qualifications / Skills Required

 

KNOWLEDGE/SKILLS/ABILITIES:

  • Plan document/ Plan benefit understanding (Medical, Dental, Vision)
  • Proficient with medical coding to include ICD-10, HCPCS, CPT and coding principles
  • Medical/Dental/Vision claim handling experience and/or claims auditing
  • Ability to interpret and execute plan set-up based on plan design documentation
  • Ability to make independent decisions from error trends identified
  • Strong analytical and organizational skills with attention to detail.
  • Advanced use of Microsoft Office Products (ex. Excel skills: formulas, ability to create, edit and run reports).
  • Highly organized and able to quickly prioritize multiple assignments with high quality results
  • Attention to detail and accuracy while focusing on overall project deliverables. Strong project management skills
  • Strategic thinking skills
  • Problem solving skills

EDUCATION/EXPERIENCE:

  • Associates degree and/or an equivalent combination of education and experience
  • Benefit coding experience (1-2 years preferred)
  • Medical/Dental claims processing or customer service in a healthcare environment (1-2 years preferred)

If you have gotten to this point and it sounds like you, check out the perks of working with us!

Some perks of working at TML Health

  • 100% paid employee medical premiums
  • Vacation - 10/15 days/yr.
  • Sick Leave - 88 hrs/yr.
  • Personal Leave - Up to 3 days/yr.
  • Holiday - Up to 8 Paid Days
  • Employee Recognition Awards
  • Staff Appreciation Event
  • Employer pays 6.2% into 457 Retirement Plan
  • Education/Training Reimbursement
  • Casual Work Environment
  • Wellness Program

We are proud to display our core values & mission:

https://tmlhealthbenefits.org/Forms/TML/HumanResources.aspx

If you are ready to support our team and help make a difference, we want to hear from you!



To Apply
Please apply by completing the form linked below. To request accommodation for filling out the application, call 512-719-6767.