The Health Plan Expert will play an integral role across all internal Hi Neo teams using a unique blend of technical, analytical, and business process knowledge, specific to the data sets used in the field of healthcare delivery and its financial transactions, to serve as a Subject Matter Expert (SME) and provide actionable insights and strategies in support of both company growth and client success.
WHAT YOU WILL DO
- Maintain a current deep knowledge base, commiserate with a SME, of the technical and practical workings of health plans as they relate to offering coverage to individuals and families nationwide.
- Inform internal teams of awareness regarding state and local level regulations that may impact healthcare data use through advanced access and/or restrictions.
- As a SME, be the go-to resource and internal educator on details and changes to:
- plan structures, costs, reimbursement rates, and limits.
- coding systems and process flows related to claims processing; and
- methods tools and data sources related to the health care delivery and rate setting markets.
- problem-solving in the event of incongruent data as it relates to benefits and service pricing.
- Utilize extensive health system data knowledge to collaborate internally on interconnected technical and structural systems of health plans, delivery of care, and healthcare service costs.
- Participate as a health plan expert, as requested, on project teams related to client build-out; special projects; company growth initiatives.
- Assist clients in defining metrics which measure desired outcomes in concert with organizational goals.
- Provide guidance to internal teams regarding plans specifics, and metrics to measure desired outcomes, to ensure the clients’ needs are fully understood and met.
- Guide internal teams on client implementations, including feasibility studies of special projects, maintaining an eye toward simplifying workflow process with business rule reuse.
- Participate in build-out requirements for reporting metrics at all levels of business.
- Offer SME insights on data set choices and appropriate resources for use in analysis of plans, client outcomes, value propositions, and company initiatives, as required for continued alignment with organizational strategy. Manage project teams as requested.
WHAT YOU BRING
- College Degree, preferably in a related field.
- 10 years’ experience with the development and structure of health plans, particularly in the private, employer-based market with deep knowledge of healthcare benefit design and deployment
- 5 years’ experience with specific systems of codes with the healthcare delivery market, including, but not limited to: EDI transaction types related to claims and eligibility, ICD-10, CPT and DRG codes.
- Working knowledge commiserate with job duties in HIPAA, Transparency in Coverage, ERISA, and other relevant governing legislation.
- Experienced in qualitative data analytics and report design for both customer facing entities and internal monitoring.
- Comfortable participating in teams of varied expertise in both leadership and functional roles.
- History of success in working with disparate groups of stakeholders to define appropriate metrics and align varied expectations of outcomes in concert with organizational goals.
- Maintains a high level of integrity and professionalism in all interactions and is equally comfortable interacting with leadership as with functional team members.
Strong analytical skills including critical thinking, research and data literacy that are further enhanced with the ability to take initiative in presenting insights that may enhance, or adversely effect, business function.
OTHER STUFF
Work is performed in an office environment and requires the ability to sit at desk for long periods of time and operate standard office equipment.
PERKS
In addition to your competitive salary, medical/dental/vision plan, and 401(k), we’ll shower you with perks, including:
- Hybrid schedule
- Paid Holidays
- Unlimited PTO
- Great people to work with
Salary Range: $ 65,000 – 85,000
Culver City, CA Remote
Join us in revolutionizing the healthcare industry through user acquisition strategies. Apply today and be part of our mission to bring transparency and affordability to healthcare pricing. Email your resume to careers@hineo.com.
