Encounters Systems Analyst III

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October 19

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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

• Compile and analyze Encounter data • Provide analytical support and leadership for Claims Encounters Regulatory Data projects • Responsible for reviewing Encounter rejections and providing resolution of minor to complex data issues or process changes • Provide Claims Encounter Subject Matter Expertise (SME) for both CMS and State agencies and internal CareSource impacted organizations (IT, Claims, New Business, Enrollment, etc.) • Build, sustain and leverage relationships with persons within his/her responsibility to constantly allow for continuous improvement of the Encounter Data business process • Direct responsibility for the design, testing and delivery of supporting processes to the business • Lead the claims data processes to ensure accuracy and compliance with CMS and state agencies

🎯 Requirements

• Bachelor’s degree or equivalent years of relevant work experience is required • Minimum of five (5) years of managed healthcare, claims, or managed care regulated environment experience is required • Minimum of five (5) years of experience using at least two of the following tools is required: SQL, SAS, SSIS, MySQL, ORACLE, R, or PowerBI

🏖️ Benefits

• Comprehensive total rewards package • Bonus tied to company and individual performance