The Health Plan (HP) Benefits Analyst I is the entry level position within the HP Benefits Analyst series of positions. HP Benefits Analyst I is responsible for utilizing the Division of Financial Responsibility (DOFR), Health Plan guidelines, Evidence of Coverage (EOC), Health Plan portals and information reported by the Health Plan to update internal databases with current and accurate member benefit information. The HP Benefits Analyst I is responsible for processing benefit verification requests. Professional Duties Utilize pre-established priority guidelines to process and/or anticipate the needs for internal benefits verification requests in an efficient and timely manner. Utilize information reported by Health Plans to update internal databases with current and accurate member benefit information. Audit member financial responsibility reported by the health plan and internal eligibility department to confirm that member financial responsibility is accurately documented. Identify discrepancies and make appropriate corrections Process benefit verification requests in accordance with Health Plan rules, guidelines and regulations. Ensure that each benefit has the correct financial risk based on DOFR. Ensure that documentation utilized to verify benefits is available for future reference. Contact Health Plan to confirm member benefit information. Identify data entry errors, review data for other pertinent employer groups and report findings to management. Assist with managing benefit documents, this includes, but is not limited to: scanning, printing and filing. Assist with quarterly audits to ensure rules and guidelines are in compliance with assigned Health Plans. Provide and distribute member benefit information to internal departments. Obtain member information needed from various sources and scan information into applicable databases for distribution to other departments. Perform other duties as assigned. Serve as an ambassador for Desert Oasis Healthcare and Family Hospice Care at all times and positively shape the customer experience Introduce self and your role Help others, offering to assist (Ask, how may I help you?) Do your share. Do what you say you will do and take action, follow through. Be willing to pitch in and help Let your patients, customers and co-workers know what they can expect from you and follow through Be an active listener (make eye contact, validate) Assume a neutral position and suspend judgment of others Address customers as Mr., Mrs., or Ms. until invited to do otherwise. Never use terms of endearment such as hon, dear, sweetie, etc. Be accountable for your work Be sensitive to factors that influence customers and co-worker's situation including age, gender, culture, race and socioeconomic status. Be observant of others' social cues (emotions) and respond appropriately Speak clearly and use understandable language (avoid medical jargon or slang) Validate to ensure understanding Use open-ended questions to engage Demonstrate appropriate body language and tone of voice Answer all phone calls with a salutation, introduction and offer to assist (Good afternoon, Desert Oasis Healthcare or Family Hospice Care, this is (your name), how may I help you?) Speak positively about your work, co-workers and Desert Oasis Healthcare and Family Hospice Care Avoid gossip and negativity Offer to answer any additional questions that the person, patient or customer may have Qualifications High School diploma or equivalent. 1 year of healthcare experience that includes experience working with HMO Senior Health Plans and/or Commercial Health Plans, preferred. Knowledge with Healthcare and Managed Care, preferred. Knowledge of diagnosis and procedures codes, preferred. Familiar with referrals and claims process, preferred. Ability to utilize Microsoft Office Suite applications/software (Word, Excel, Power Point, Excel). Ability to manage time and prioritize tasks to meet deadlines At the discretion of

DOHC/FHC

management, this position has the potential to be a full or hybrid telecommuting position.

Physical Demands Sitting:

Approximately 70% of day.

Standing:

Approximately 15% of day.

Walking:

Approximately 15% of day.

Lifting:

0-40 lbs. approximately 5% of day.

Bending:

Approximately 5% of day. Kneeling approximately < 5% of day.

Hearing/Visual Acuity:

Adequate for use with computers, telephone/mobile devices and other office equipment approximately 50% of day.

Computer:

Highly technical work environment. Must be able to work 6+ hours per day using computers, telephone/mobile devices and other office equipment.

Reaching:

Above head 75 degrees approximately 25% of day.

Hand grip dexterity:

Approximately 40% of day.