Aultman Health Foundation Job - 40087180 | CareerArc
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Company: Aultman Health Foundation
Location: Canton, OH
Career Level: Associate
Industries: Healthcare, Pharmaceutical, Biotech

Description

PURPOSE OF POSITION:

The primary purpose of the Senior Contract Specialist is to support the Retention Department by functioning as liaison between Retention, Underwriting, Enterprise Risk Management (ERM), Technical Support, Claims and Customer Service, Information Systems, and Pharmacy in the creation of the Electronic Benefit Specifications (EBS) checklist to ensure that client requirements are met. Responsible for coordinating the EBS and manual checklist production and distribution to all necessary departments, ensuring accurate and timely documentation. Preparing and maintaining Summary Benefit and Coverages (SBC) for all product benefit plans.

 

RESPONSIBILITIES & EXPECTATIONS:

  • Responsible for the production and maintenance of EBS and manual checklists for all products, including; medical, dental, vision, HMO, MEWA, Market Place, Health Reimbursement Accounts (HRA) and short-term disability, ensuring accurate and timely communication to the Operational departments via the Plan Change Database.
  • Maintain all documentation of new and renewing clients' requested benefits and benefit changes, underwriting approval, and revisions thereof.
  • Provide clarification of benefit provisions through working with the Account management team, Underwriting, Technical Support and ERM.
  • Maintain correctness of the EBS database, which includes more than 1,500 active and 2,500 archived checklists. The accuracy of the checklists supports the creation of the benefit plan design built in the system, the Summary Plan Description (SPD) for Self-Funded clients, benefits posted to the website, and a resource for Claims Processing and Customer Service to pay and quote benefits.
  • Facilitate EBS database improvements by adding specifications required for new benefit provisions, updating questions, benefit selections, printable checklists and reports.
  • Retaining knowledge of, and staying current with, the regulations guiding the SBC. 
  • Prepare and maintain SBC's for all plans and assist in the creation and updating of the SBC calculation tables.
  • Update and maintain the market place plan designs and changes in the Market Place database, including the accurate completion of the benefits to the portal.
  • Possess an in-depth knowledge of healthcare benefits, language and industry standards.
  • Possess knowledge of both competitor's and AultCare's claim processing guidelines.
  • Possess an in-depth knowledge of the plan building process to assist the Account Coordinator in identifying potential claim processing or plan set up issues.
  • Be knowledgeable about federal and state regulations to ensure benefit design, eligibility guidelines, etc., are compatible with regulations.
  • Be knowledgeable of Compliance and Utilization Management guidelines.
  • Provide leadership role for Account Coordinators completing checklists on the EBS tool.
  • Develop policies and procedures for standardized use of the EBS tool by Account Coordinators.
    • Provide training to internal and external departments regarding the EBS tool.
    • Act as single-point-of-contact for Account Coordinator's for technical issues related to the EBS tool.
    • Interface with AultCare Information Systems to effectively develop technology solutions for Retention processes with the EBS system.
    • Act as point-of-contact for Phase II implementation of the EBS system – understanding, clarifying and prioritizing the needs of other departments.
  • Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
  • Seeks supervisory guidance/approval as appropriate.
  • Portrays professional image: follows dress code; communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.
  • Promotes and demonstrates professional standards to enhance the development of the department including.
  • Practices ethical conduct.
  • Meets acceptable attendance and punctuality expectations (excluding FMLA)

The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and is not a detailed description of all the work requirements that may be inherent to this position.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or protected veteran status.  AultCare is an EEO/AA Employer M/F/Disability/Vet.

AultCare/AHF will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on AultCare/AHF or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the AultCare Human Resource Department and request such accommodation. 

 

QUALIFICATIONS:

  • Education:  Bachelor's degree preferred.  
  • Minimum two years of insurance benefits and customer service experience.
  • Excellent written and verbal communication skills
  • Ability to manage multiple tasks simultaneously and prioritize.
  • Strong skills in Microsoft Office, including Word, PowerPoint and Outlook.
  • Good problem-solving skills.

 

WORKING CONDITIONS:

  • Hours of operation, shifts as assigned. Occasional extra hours, on-call, off-shifts (evenings and/or weekends) scheduled as necessary.
  • Office environment with moderate noise level.
  • Frequent sitting, use of hands/fingers across keyboard or mouse, and long periods working at a computer.
  • Occasionally walking, standing, twisting/turning and reaching upward or forward during work day.


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