CareSource je zdravstvena zavarovalnica, ki svojim članom nudi storitve prek načrtov Medicaid, Marketplace in Medicare Advantage. Njeno kritje in podporne storitve so namenjeni skupinam, med katerimi so odrasli in družine z nizkimi dohodki, otroci, nosečnice, starejši odrasli in osebe z invalidnostmi. CareSource zagotavlja tudi vire podpore na področju zobozdravstva, vida, sluha, lekarniških storitev in podpore, povezane s COVID-19, ter spletna in mobilna orodja, ki članom pomagajo upravljati zdravstveno varstvo.
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.
Opis
- 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.
Zahteve
- 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.
Ugodnosti
- A bonus based on company and individual performance may be available.
- Comprehensive total rewards package.
- Support for employee well-being.