Configuration System Analyst II - Benefits Configuration

Job not on LinkedIn

July 25

🎸 Mississippi – Remote

Although this job is listed in Mississippi, this company may be open to hiring remote in other states.

💵 $63.7k - $101.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

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CareSource

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Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

📋 Description

• Leads and defines system requirements associated with Member Benefits, Provider Reimbursement and payment systems requirements definition, documentation, design, testing, training and implementation support using appropriate templates or analysis tools. • Identify, manage and document the status of open issues. • Develop and utilize reports to analyze and stratify data in order to address gaps and provide answers to issues identified within the department or by other departments, utilizing TriZetto or Optum for research and correction. • Utilize available tools provided by relevant State or Federal websites to obtain pertinent Fed/State Regulatory Transmittals and Fee Schedules. • Plan/implement new software releases including testing and training. • Serve as liaison between IT and business areas to research requirements for IT projects. • Lead review of benefits or provider reimbursement as well as identify and design appropriate changes. • Provides detail analysis of efficiencies related to system enhancement/automation. • Audit configuration to ensure accuracy and tight internal controls to minimize fraud and abuse and overpayment related issues.

🎯 Requirements

• High School Diploma or GED is required • Bachelor’s Degree or equivalent years of relevant work experience is preferred • Minimum of three (3) years health plan experience, to include two (2) years of configuration or clinical editing software experience is required • Exposure to Facets is preferred • Advanced computer skills with Microsoft Word, Excel, Access, Visio and abilities in Facets • Proven understanding of database relationships required • Understanding of DRG and APC reimbursement methods • Understanding of CPT, HCPCs and ICD-CM Codes • Knowledge of HIPAA Transaction Codes • Critical listening and thinking skills • Decision making/problem solving skills • Enhanced communication skills both written and verbal • Attention to detail • Understanding of the healthcare field • Knowledge of Medicaid/Medicare Claims processing skills • Proper grammar usage • Time management skills • Proper phone etiquette • Customer service oriented • Facets knowledge/training • Proper claim coding knowledge • Ability to be telecommuter • Broad understanding of business considerations and functionality preferred

🏖️ Benefits

• In addition to base compensation, you may qualify for a bonus tied to company and individual performance. • We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.