CareSource
CareSource
CareSource Medicaid, Marketplace va Medicare Advantage rejalari orqali aʼzolariga xizmat ko‘rsatuvchi tibbiy sug‘urta kompaniyasidir. Uning qamrov va qo‘llab-quvvatlash xizmatlari kam daromadli kattalar va oilalar, bolalar, homilador ayollar, keksalar hamda nogironligi bo‘lgan shaxslarni o‘z ichiga olgan guruhlar uchun mo‘ljallangan. CareSource shuningdek stomatologiya, ko‘rish, eshitish va dorixona xizmatlari, COVID-19 bo‘yicha yordam resurslari hamda aʼzolarga tibbiy xizmatlarini boshqarishda ko‘maklashadigan onlayn va mobil vositalarni taqdim etadi.

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.

Tavsif

  • 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.

Talablar

  • 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.

Imtiyozlar

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

O‘xshash ish o‘rinlari

Northern Star Resources Limited

Reliability Planning Project Coordinator — Alaska

Northern Star Resources Limited
1 001 – 5 000 Xodimlar
B2BKorxona

Lead maintenance reliability, planning, scheduling and project execution at Northern Star Resources’ remote Alaska gold-processing plant. Improve work management discipline and equipment performance across the site.

Ochish
NYCM Insurance

Customer Experience Coaching Coordinator — NYCM Insurance (Hybrid, New York)

NYCM Insurance
501 – 1 000 Xodimlar
MoliyaSug‘urta

Lead the design and improvement of customer interaction coaching programs at NYCM Insurance. Use coaching metrics and customer feedback to strengthen frontline performance and consistency.

Ochish
Simpson Thacher & Bartlett LLP

Legal Talent Events Coordinator — Simpson Thacher, New York (Hybrid)

Simpson Thacher & Bartlett LLP
1 001 – 5 000 Xodimlar
H1B vizasi homiysiHuquqKonsaltingMoliya

Coordinate recruiting, professional development, and employee engagement events for Simpson Thacher’s Legal Talent team. Oversee event planning, communications, vendors, and onsite logistics in a hybrid New York role.

Ochish
ExamWorks

Remote Clinical Quality Assurance Coordinator (RN, LPN, or LVN)

ExamWorks
5 001 – 10 000 Xodimlar
HuquqKonsaltingSog‘liqni saqlash

Review peer review reports for MCMC, a healthcare utilization and quality review provider, to help ensure clinical accuracy, compliance, and complete documentation. This full-time remote role is open to licensed nurses in the United States.

Ochish
CrossCountry Consulting

Senior Recruitment Operations Coordinator

CrossCountry Consulting

Coordinate recruiting operations for CrossCountry Consulting’s advisory services, talent systems, and internship program. Manage recruiting data, interview logistics, coordinator processes, and executive candidate experiences.

Ochish