Payment Cycle Analyst II

Job not on LinkedIn

November 20

🎰 Nevada – Remote

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

💵 $61.5k - $98.4k / 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

• Provide analytical support and leadership for key Claims-related projects and initiatives • Define clinical and payment policy requirements to support configuration of clinical editing system • Conduct and research potential new reimbursement policy claim edits • Research claim results to determine potential errors/discrepancies • Conduct both systemic and targeted analysis to identify reimbursement errors and determine root cause • Ensure that all clinical and payment policy analysis and documentation is prepared, reviewed, and approved prior to implementation • Provide input to UAT and conduct post production validation of implementation results • Create effective written and oral communication materials that summarize findings and support fact based recommendations • Document the status of open issues, configuration design, and final resolution • Review and interpret regulatory items, timely delivery of required updates • Provide support of system change policy initiatives, provide updates in payment policy meetings, and present to stakeholders • Monitor configuration and Claim SOPs to ensure accuracy of claim payments • Assist in the development of policies and procedures for claims processing, COB, appeals and adjustment functions • Ensure payment policies and decisions are documented and collaborate with the Health Partner team

🎯 Requirements

• Bachelor’s degree or equivalent years of relevant work experience • Minimum of three (3) years of health plan experience is required or equivalent experience with provider coding and claim payment policies • Experience working with clinical editing software is preferred • Advanced proficiency level experience in Microsoft Suite to include Word, Excel, Access and Visio • Strong computer skills and abilities in Facets • Demonstrated understanding of claims operations, configuration, and clinical editing specifically related to managed care • Understanding of CPT, HCPCs and ICD-CM Codes, including strong working knowledge of Codes sets ICD-9/ICD-10, CPT, HCPC, REV, DRG and Rug • Knowledge of HIPAA Transaction Codes

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off • Professional development opportunities • Bonus tied to company and individual performance