What are the responsibilities and job description for the Benefits/Configuration Matrix Specialist (Remote) position at Morgan Stephens?
Job Title: Benefits/Configuration Matrix Specialist
Reports To: Claims Operations Director
Supervised By: Claims Operations Director
Pay: $38.00 per hour - Temp-to-perm (Benefit Plan offered)
General Purpose
The Benefits/Configuration Matrix Specialist is responsible for maintaining the accuracy and timeliness of the Benefit Matrix tables within the EZ-Cap system for all databases. This role ensures that benefits, financial responsibilities, and other configurations align with contracts, regulations, and operational needs.
Duties and Responsibilities
- Maintain and update Benefit Matrix tables in EZ-Cap, including divisions of monetary responsibility, provider configurations, payment rates, and vendor information.
- Ensure timely updates to all tables as required by changes in contracts or member benefits.
- Configure benefit categories and adjudication rules to ensure accurate claims processing.
- Interpret contract and benefit changes and implement them in the EZ-Cap database.
- Import, process, and export health plan benefit data efficiently and accurately.
- Collaborate with Claims, Utilization Management (UM), and Contracting departments to ensure system configurations align with member benefits and financial liability rules.
- Identify opportunities to improve and automate processes, expediting system updates while ensuring quality and data integrity.
- Stay informed about industry trends and health plan benefit changes to support managed care operations.
- Review monthly audit results to validate accurate benefit configuration.
- Evaluate provider appeals and make necessary corrections to EZ-Cap configurations.
- Resolve issues within the scope of authority, coordinating with other departments to ensure resolutions are achieved.
- Adhere to company policies and procedures.
- Perform other tasks or assignments as directed by the Claims Supervisory Team and upper management.
- Ability to lift up to 10 pounds.
- Ability to sit for extended periods, up to three hours at a time.
Qualifications
- Minimum of three years’ experience in claims processing and/or auditing.
- Internal or external audit experience is preferred.
- Ability to work effectively with minimal supervision.
- Proficient in medical terminology, CPT, ICD-9, revenue codes, and HCPCS codes.
- Strong verbal and written communication skills.
- Excellent organizational and interpersonal skills.
- Experience with EZ-Cap claims modules and functionalities.
Salary : $38
