Benefits Specialist

Job Title : Benefits Specialist

Department : Administration

Reports To : Practice Administrator

FLSA Status : Non-Exempt (Hourly)

Work Schedule: Monday-Friday, Generally 8:00 A.M. - 5:00 P.M.

Summary:

The Benefits Specialist provides excellent customer service by assisting employees of Orthopaedics East & Sports Medicine Center (OrthoEast). Primary responsibilities include administrative support of benefits programs and maintaining the benefits strategy and the associated policies, procedures, and processes. This position may also manage the credentialling requirements for all our providers.

This position requires compliance with OrthoEast’s compliance standards, including its Code of Conduct, Compliance Program, and policies and procedures. Such compliance will be an element required as part of the job duties and considered during performance evaluations.

Essential Duties and Responsibilities:

• Administers OrthoEast’s benefits programs, including, but not limited to, medical, dental, vision, health savings accounts, COBRA, ancillary benefits, and retirement benefits according to plan provisions and in compliance with federal, state, and local laws and regulations.
• Manages the annual open enrollment project and process, including project planning, collaboration with vendors, communications, meetings, system configuration updates and testing, employee enrollment, post-enrollment audits, etc.
• Audits employee benefits to ensure compliance with plan structure and company policy and resolves discrepancies. Troubleshoots issues and resolves problems related to the plans, eligibility, enrollment, systems, etc.
• Assist in developing benefits education programs designed to increase engagement and enhance the value of new and existing benefit programs.
• Develops, updates, reviews, and distributes print and electronic benefits communications. Also, advises employees and managers on eligibility, coverage, and other benefits.
• Manages researching, filing, and completing all government requests that pertain to employees of the practice.
• Complete wage audits that we receive from NC Department of Commerce.
• Handles all wage garnishment requests for various reasons (IRS, Child Support, etc.)
• Completes all on-boarding processes for New Hires, including but not limited to EVerify and NC Hires
• Other duties as required

Position may possibly include credentialing requirements:

• Processing initial credentialing and re-credentialing applications for Orthopaedics East & Sports Medicine Center and practice clinic locations as needed. Also, researching, developing, writing, and updating credentialing policies, procedures, methods, and guidelines.
• Ensuring all providers are appropriately credentialed and monitor staff credentials and licenses. Also, maintain current copies of current state licenses, DEA certificates, and any other required credentialing documents for all providers.
• Compiling and maintaining current and accurate data for all providers, including CAQH files, in credentialing databases and spreadsheets. Organizes and maintains physical and online ASC and provider files. Enrolls ASC and provides information to insurance payors as needed.
• Communicates with representatives of MCO’s, CIN's, and insurance companies for follow-up of applications and any other identifying issues requiring additional investigation and evaluation.
• Audits health plan directories for current and accurate provider information and provides health plans with up-to-date information pertaining to providers to avoid billing denials.

Education and/or Experience:

• 4-year degree in a related field or equivalent experience preferred.
• 2 or more years of experience in Benefits administration required.
• Experience in Credentialling preferred.
• Strong analytical skills with demonstrated experience in benefits.
• Proficient in Excel.
• Strong interpersonal and communication skills.

Required Behaviors:

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to stand; walk; use hands and fingers, handle, or feel and talk or hear. The employee is frequently required to reach with hands and arms. The employee is occasionally required to sit and stoop, kneel, or crouch. Occasionally lifting and/or moving up to 20 pounds.