Payment Cycle Analyst III

Job not on LinkedIn

🕒 6 days ago

🇺🇸 United States – Remote

💵 $72.2k - $115.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

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.

📋 Description

• Conducting both systemic and targeted analysis to identify reimbursement errors and determine root causes • Collaborating with Configuration, Configuration UAT, Enterprise UAT, IT Claims, and Payment Cycle Team members to ensure comprehensive test scripts • Providing analytical support and leadership for special projects and initiatives related to reimbursement of claims for both providers and members • Researching claim results to determine potential errors/discrepancies attributed to clinical edits, claims coding, payment policies, and application of fee schedules and rates • Developing business requirements for payment decisions and managing the implementation process • Leading special projects to ensure payment discrepancies are resolved and communicated to appropriate parties • Reviewing and interpreting regulatory items and policy manuals

🎯 Requirements

• Bachelor's degree required • Five (5) years of health plan experience is or equivalent experience with health plan operations and configuration required • Experience with user testing required • Experience with payment methodologies and industry pricers (ex: DRG, APC, SNF, RBRVS) preferred

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development training • Bonuses • Comprehensive total rewards package