Payment Cycle Analyst IV

Job not on LinkedIn

🕒 May 20

🇺🇸 United States – Remote

💵 $83k - $132.8k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🧐 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

• Payment Cycle Analyst IV is responsible for conducting both systemic and targeted analysis to identify reimbursement errors and to determine root cause. • Collaborating with Configuration, Configuration UAT, Enterprise UAT, IT Claims, and Payment Cycle Team members to ensure test scripts are comprehensive. • Proactively collaborates with various teams to support contracting implementations and resolution of complex claims issues. • Validate MCA Tests for expected results and communicate information to Reimbursement Analysts and HP Managers for provider notification. • Create effective written and oral communication materials that summarize findings and support fact-based recommendations

🎯 Requirements

• Bachelor’s degree or equivalent years of relevant work experience is required • Minimum of seven (7) years of health plan experience is required or equivalent experience with health plan operations and configuration • Experience with user testing is required • Experience with payment methodologies and industry pricers (ex: DRG, APC, SNF, RBRVS) is preferred

🏖️ Benefits

• Bonuses tied to company and individual performance • Substantial and comprehensive total rewards package