Medical Policy/Benefits Analyst job at AlohaCare in Honolulu

AlohaCare is hiring Medical Policy/Benefits Analyst on Sat, 04 May 2013 06:29:13 GMT. In collaboration with AlohaCare’s Medical Directors, researches, develops, and maintains AlohaCare’s policies and guidelines regarding medical necessity and appropriateness. Develops AlohaCare’s benefit coverage policies using Evidence of Coverage information, CMS and DHS contractual requirements, and health plan reimbursement policies. Performs all activities related to the appropriate...

Medical Policy/Benefits Analyst

Location: Honolulu Hawaii

Description: AlohaCare is hiring Medical Policy/Benefits Analyst right now, this job will be placed in Hawaii. More complete informations about this job opportunity please read the description below. In collaboration with AlohaCare’s Medical Directors, researches, develops, and maintains AlohaCare’s policies and guidelines regarding medical necessity and appropriateness. Develops AlohaCare’s ben! efit coverage policies using Evidence of Coverage information, CMS and DHS contractual requirements, and health plan reimbursement policies. Performs all activities related to the appropriate administration of benefits ensuring compliance with Medicaid and Medicare coverage guidelines. Responds to requests from internal departments for information and training on AlohaCare’s medical necessity guidelines and coverage of benefits.

Essential Responsibilities:
Researches national and/or locally accepted medical necessity guidelines, solicits input from appropriate staff and develops initial AlohaCare medical necessity guidelines for review with the Medical Directors

Works with the Medical Directors on research and development of medical policies to guide benefit coverage decisions; develops clear, concise documentation of policy and benefit requirements

Maintains and assures periodic review of all medical coverage policies

Uses a! variety of resources including but not limited to online info! rmation/databases, Medicare and Medicaid guidelines and requirements

When required, obtains policy/guideline approval from applicable committee(s)

Communicates approved medical necessity and benefit coverage policies/guidelines throughout the organization

Maintains a library of approved policies and guidelines on SharePoint and assures timely notification to appropriate staff of new or revised guidelines

Researches and interprets changes in benefit coverage and communicates any required benefit setup changes to Business Analysis staff

Serves as primary contact for benefit related questions and issues

Consults as needed with the senior leader responsible for plan benefit designs to create and maintain benefit coverage and exclusions documents that serve as reference for staff

Works with Medical Directors and clinical staff to assure consistent application of approved guidelines

Provides medical guideline! s and benefit coverage related training to staff

Maintains benefit plan design and performs regular review of benefit design to ensure proper setup and the accuracy of member cost share applied during claims processing

Documents results of reviews and works with Business Analysis Team on benefit configuration

Pursues professional development as necessary to enhance job performance.

Position Requirements:
Bachelor's degree in Nursing or Pharmacy or equivalent

3-5 years of experience with managed care or health insurance environment, including experience with medical policy and benefit coverage development

Familiar with CMS and DHS contract requirements

Knowledge of healthcare system and factors that affect adoption and implementation of new and emerging healthcare technologies and procedures

Strong literature searching skills and ability to synthesize complex information

Working knowl! edge of policies and procedures (specifically in healthcare)

A! bility to quickly synthesize volumes of information on health technologies and clinical trials in wide variety of clinical areas

Analytical and detail oriented

Able to effectively communicate with others at all various levels

Able to problem-solve and communicate solutions

Must be capable of working under tight deadlines, with the flexibility to work on several projects concurrently

Able to type multi-page documents

Able to work in a high stress environment at times, with pressure of deadlines and multiple projects

Computer literate; intermediate to advanced proficiency with Windows-based programs and applications

Preferred Requirements:
Clinical Training

An Equal Opportunity Employer
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to AlohaCare.

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This job starts available on: Sat, 04 May 2013 06:29:13 GMT

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