Market Liaison Resolution Specialist

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $54.5k - $87.3k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

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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

• Achieving resolution of Operational Intakes by the Market Liaison Support Services Research Team • Conduct detailed reviews and document findings • Collaborate with various departments including contracting, credentialing, claims, and IT • Investigate Market State Complaint tasks • Meet Service Level Agreements (SLA) • Generate reports to determine claim impact • Adjust impacted claims and assist in adjudication • Identify opportunities for process improvements • Participate in User Acceptance Training of system issues • Communicate effectively with internal departments • Assist the market proactively by evaluating risks

🎯 Requirements

• Bachelor's degree required • Two (2) years of experience in managed care operations required • Knowledge of Medicaid/Medicare • Familiarity with healthcare industry • Understanding of Provider Contracting applications • Advanced troubleshooting and problem-solving capabilities • Overall knowledge of Managed Care Operations-related systems, medical coding, technical specifications, and processes • Solid understanding of claims processing • Proficient in Microsoft Office Suite • Effective organization, time management, and prioritization skills

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development opportunities • Bonuses