Virginia Premier Health Plan, Inc.

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Benefit Analyst - Certified Professional Coder

Benefit Analyst - Certified Professional Coder

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Job Description




The Benefit Analyst maintains the integrity of the plan benefits for each program and is responsible for developing an extensive expertise of all plan benefits.  The Benefit Analyst will work closely with Virginia Premier’s Program Departments to ensure benefits are compliant with state and federal guidelines, as well as aligned with program initiatives. This position is responsible for coordinating and maintaining benefit design for the organization. As such, this individual may also be utilized to assist with training staff regarding benefit structure for a specific program or programs.  In addition to maintaining the benefits, the Benefits Analyst will also QA the claims system(s) to ensure the benefit configuration meets requirements set forth by the program.




  • Provides administration and maintenance of benefit design documents across the different lines of business, ensuring the integrity of the benefit tables.
  • Ensure the program is compliant with federal and state benefit guidelines
  • Assist in planning and designing of  benefit programs
  • Leverage analytical skills to review benefits
  • Support new Line(s) of Business by developing the benefit matrices to support Program benefit policies
  • Partner with Business Development to review new program benefits
  • Assist with translation of plan benefit, Virginia Program, and Out of State program requirements
  • Engage appropriate internal resources to resolve benefit issues
  • Coordinate cross functional work groups to address changes in priorities and new implementation benefit requests
  • Interacts with internal departments to understand business requirements and provide direction to the team for implementation
  • Recommends and obtains approval for appropriate benefit(s) for implementation
  • Lead requirements gathering sessions with implementation team, and other internal departments, as well as external vendors and subcontractor
  • Ensure that established processes/procedures are followed as designed. Review, respond and provide supporting documentation for internal configuration audits
  • Testing and QA of benefits in the claim system(s) to validate benefits are aligned accordingly
  • Oversee Benefit Grid and maintenance
  • Other duties as assigned



  • Bachelors degree in health related field preferred


  • Ability to comprehend and interpret state and federal contracts
  • 2-3 years of Medicare and Medicaid benefits experience preferred
  • Knowledge of CPT, ICD-9/10 and HCPS coding system
  • Ability to make proper decisions quickly  and complete complex projects
  • Proficient knowledge of Microsoft Office (Access & Excel)
  • A team player who manages multiple projects simultaneously in a fast paced environment
  • Excellent interpersonal skills, including the ability to work with all levels of personnel including, but not limited to peers and Senior Management within the organization.
  • Excellent written and oral communication skills
  • Ability to process map and effectively document operating procedures for the system implementation


  • Ability to communicate with varied levels in the organization
  • Knowledge of healthcare and benefits administration


  • Physical health sufficient to meet the ergonomic standards and demands of the position.

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 


We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  


All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE


Our mission is to inspire healthy living within the communities we serve!

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