Configuration Systems Analyst III

Job not on LinkedIn

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $83k - $132.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Systems Engineer

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

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

• Manage and define system configuration requirements • Handle requirements definition, documentation, design, testing, training and implementation support using appropriate templates or analysis tools • Develop and use reports to analyze and stratify data, address gaps and provide answers to departmental issues • Identify, manage and document open issues, configuration design and final resolutions in the change management system • Review and interpret regulatory items and deliver required updates on time • Develop standard code sets and reimbursement design templates • Plan and implement new software releases, including testing and training • Participate in meetings with business owners, users and IT to achieve solutions meeting requirements and expectations • Lead configuration initiatives in payment policy meetings and present to committees • Coordinate annual benefit changes with internal resources • Analyze system efficiencies and document effectiveness of existing systems; develop improvement and leveraging strategies • Manage reimbursement reviews and design appropriate changes • Lead development and execution of test plans and scenarios for reimbursement designs and related processes • Audit configuration for accuracy and internal controls to minimize fraud, abuse and overpayment issues • Anticipate customer needs and match products and services to fulfill those needs • Ensure system processes and documents exist as a basis for system logic • Manage resources and communications to facilitate work completion • Mentor use of tools to define requirements • Perform other duties as requested

🎯 Requirements

• High School Diploma or GED is required • Bachelor’s degree or equivalent years of relevant work experience is preferred • Minimum of five (5) years of health plan experience, including three (3) years of configuration or clinical editing software experience is required • Exposure to Facets or equivalent system is preferred • Exceptional computer skills and abilities in Facets • Advanced proficiency in Microsoft Suite, including Word, Excel, Access and Visio • Proven understanding of database relationships • Understanding of DRG and APC reimbursement methods • Understanding of CPT, HCPCs and ICD-CM Codes • Knowledge of HIPAA Transaction Codes • Effective listening and critical thinking skills • Effective problem solving skills with attention to detail • Excellent written and verbal communication skills • Ability to work independently and within a team environment • Strong interpersonal skills and high level of professionalism • Ability to develop, prioritize and accomplish goals • Understanding of the healthcare field and knowledge of Medicaid and Medicare • Proper medical coding knowledge and claims processing skills • Customer service orientation • Facets knowledge/training • Ability to manage vendor relationships • Certified Medical Coder (CPC) is preferred

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Employee total well-being support