We are creative, collaborative, and a little bit fiery. The Bind team is comprised of like-minded individuals passionate about healthcare, and our cause is the collective act of rewiring it. We embrace new ideas. We're more wheel than cog. More spark than smoke. And we are playful and venturesome in our daily mission to render real and refreshing solutions to health insurance that works better for us all.
We are seeking an experienced Benefit Design and Coding Specialist to join our growing team. In this position, you will play a key role in enabling the Bind benefit plan by reviewing and analyzing the benefit plan and partnering with Plan Design, Clinical and Operations subject matter experts to ensure use and adoption of appropriate coding standards through the development, implementation and administration of the Bind benefit coverage specifications.
Participate in development and maintenance of code sets across Bind capabilities.
Assist in enabling the Bind benefit plans by reviewing and analyzing intent, coding and configuration.
Review Bind benefit plan for accuracy and completeness of codes, ensuring all codes are current and active.
Conduct regular review of benefit plan codes to maintain compliance with standards.
Ensure compliance with member benefit regulations across Bind plan designs (Mental Health Parity, etc.)
Create and maintain coverage specifications for Bind plan designs.
Partner with Plan Design, Clinical and Operations to develop and maintain program/solution documentation and specifications.
Participate in the process for maintaining codes within the coverage specifications.
Collaborate with Plan Design Benefit and Coding Manager to provide subject matter expertise for claim processing, ensuring appropriate interpretation and application of medical coding standards in setup and configuration of claim adjudication engine.
Ensure all appropriate codes are assigned and sequenced as needed.
Serve as a resource regarding coding questions and interpretation of standards; provide support on use of codes and changes to coding standards as needed.
Assist in translation of consumer-friendly medical terms and concepts into the proper clinical codes.
Ensure adherence to state and federal compliance policies, reimbursement policies and contract requirements.
Facilitate meetings with Account Partners, Clinical, Operations and others to achieve benefit design solutions that meet needs and expectations.
Perform additional duties as assigned.
Requirements:Bachelor's degree or equivalent years of relevant work experience.
3+ years business/operations experience in a health plan environment and familiarity with commercial plan design.
3+ years of medical benefit plan design and/or configuration and medical coding experience.
Medical Coding Certificate; RHIT or CPC by AAPC or AHIMA license or working knowledge of coding within benefit and claim adjudication.
Working knowledge of HCPCS, CPT, ICD10 CM and PCS, J codes and Rev codes.
Experience in the application of medical and reimbursement policies within the claims adjudication process.
Experience performing coverage review which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims.
Experience assisting in the plan build/plan configuration of claim adjudication platform.
Strong analytical skills.
Clear, concise, engaging and effective written and oral communication.
Willingness and ability to be both an individual contributor and a team player.
Ability to influence without direct control.
Proficient in Microsoft Word, Excel, PowerPoint, etc.
Accurate and precise attention to detail.
Bind is committed to providing equal employment opportunities. All qualified applicants and employees will be considered for employment and advancement without regard to race, color, religion, national origin, sex, disability, age, marital status, sexual orientation, veteran status, genetic information, or any other status protected by applicable law.