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CareSource
CareSource
1 001 – 5 000 Darbuotojai
H1B vizos rėmėjasDraudimasSveikatos draudimasSveikatos priežiūra
CareSource yra sveikatos draudimo bendrovė, aptarnaujanti savo narius per Medicaid, Marketplace ir Medicare Advantage planus. Jos draudimo apsauga ir pagalbos paslaugos skirtos įvairioms grupėms, įskaitant mažas pajamas gaunančius suaugusiuosius ir šeimas, vaikus, nėščiąsias, vyresnio amžiaus žmones ir žmones su negalia. CareSource taip pat teikia odontologijos, regos, klausos ir vaistinių paslaugas bei COVID-19 pagalbos išteklius. Interneto ir mobilieji įrankiai padeda nariams tvarkyti savo sveikatos priežiūrą.
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Darbai įmonėje

Remote Configuration Systems Analyst III at CareSource

Configure CareSource healthcare systems, reimbursement designs and benefit updates, with responsibility for testing and regulatory changes. Support accurate claims processing and payment policy initiatives in this remote role.

USJungtinės Valstijos
83 000 $ – 132 800 $ / metai
NuotolinisVisas etatasVidutinis lygisVyresnysis specialistasPrivaloma Kalba: anglųSistemų inžinierius

Aprašymas

  • Manage system configuration requirements.
  • Define, document and design requirements, and support testing, training and implementation with appropriate templates and analysis tools.
  • Create and use reports to analyze and segment data, address gaps and resolve departmental issues.
  • Track open issues, configuration designs and resolutions in the change management system.
  • Interpret regulatory guidance and deliver required system updates on schedule.
  • Create standard code sets and reimbursement design templates.
  • Plan and implement software releases, including testing and training.
  • Work with business owners, users and IT to develop solutions that meet requirements and expectations.
  • Lead configuration initiatives in payment policy meetings and present findings to committees.
  • Coordinate annual benefit changes with internal teams.
  • Assess system efficiency and effectiveness, documenting findings and developing improvement strategies.
  • Oversee reimbursement reviews and design suitable changes.
  • Lead test plan and scenario development and execution for reimbursement designs and related processes.
  • Audit configurations for accuracy and internal controls to reduce fraud, abuse and overpayments.
  • Identify customer needs and align products and services to address them.
  • Ensure system logic is supported by documented processes and requirements.
  • Coordinate resources and communications to complete work.
  • Guide others in using tools to define requirements.
  • Carry out other duties as assigned.

Reikalavimai

  • High school diploma or GED required.
  • Bachelor’s degree or equivalent relevant work experience preferred.
  • At least five years of health plan experience, including three years using configuration or clinical editing software, required.
  • Experience with Facets or an equivalent system preferred.
  • Strong computer skills, including expertise with Facets.
  • Advanced proficiency in Microsoft Word, Excel, Access and Visio.
  • Understanding of database relationships.
  • Knowledge of DRG and APC reimbursement methods.
  • Knowledge of CPT, HCPCS and ICD-CM codes.
  • Knowledge of HIPAA transaction codes.
  • Effective listening and critical thinking skills.
  • Strong problem-solving skills and attention to detail.
  • Excellent written and verbal communication skills.
  • Ability to work independently and collaboratively.
  • Strong interpersonal skills and professionalism.
  • Ability to set priorities and accomplish goals.
  • Understanding of healthcare, including Medicaid and Medicare.
  • Medical coding knowledge and claims processing skills.
  • Customer service orientation.
  • Facets knowledge or training.
  • Ability to manage vendor relationships.
  • Certified Professional Coder (CPC) credential preferred.

Privalumai

  • A bonus based on company and individual performance may be available.
  • Comprehensive total rewards package.
  • Support for employee well-being.

Susiję darbai

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NuotolinisVisas etatasJaunesnysis specialistasVidutinis lygisDiplomas nebūtinasPrivaloma Kalba: vokiečiųPrivaloma Kalba: anglųVerslo plėtros atstovas

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A.P. Moller - Maersk
Automobilių pramonėKonsultavimasStatyba
USJungtinės ValstijosCAKalifornijaOROregonasWAVašingtonas
100 000 $ – 125 000 $ / metai
NuotolinisVisas etatasVidutinis lygisVyresnysis specialistasPrivaloma Kalba: anglųVerslo plėtros atstovas

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