Provider Operations Analyst II – Health Plan, Provider Data Experience

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $62.7k - $100.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Assimilate large quantities and/or complicated data into meaningful formats for tracking and status requirements • Develop queries to identify and quantify provider data issues and assist with resolution plans • Provide analysis and oversight for provider data, workflows, and processes across Contracting, Credentialing, Data Load, Directories, and Pended Claims operations • Act as SME/Business Analyst/Data Analyst for Provider Operations initiatives and special projects • Work cross-functionally with Claims, Configuration, Market Representatives, and Provider Operations • Identify, develop, and implement reporting and business processes supporting data quality, operational excellence, regulatory, and compliance requirements • Develop and monitor daily staff quality and productivity metrics and recommend changes • Manage root cause analysis for high-level escalations requiring intensive research and resolution • Manage special projects involving high-dollar unpaid claims, state complaints, provider service risks, or compliance risks through resolution • Develop, document, and perform testing and validation for process and system changes • Serve as primary contact for vendors and business partners exchanging CareSource provider data • Submit operational workflow requests to update provider data • Collaborate with Talent Development to develop and present training modules • Perform other duties as requested

🎯 Requirements

• Bachelor’s Degree or equivalent years of relevant work experience is required • A minimum of three (3) years of health care or managed care experience is required • Experience working on Claims systems, preferably Facets, preferred • Experience in provider relations, contracting, onboarding, credentialing, directories, pended claims, or configuration is highly preferred • Knowledge and understanding of one or more provider systems, including Choreo/Contract Manager, Cactus and Facets • SQL/Access capabilities • Advanced MS Excel, PowerPoint, and Word skills • Proficient in data analysis • Ability to understand workflows and process improvement • Excellent organizational, collaboration, communication, facilitation, and presentation skills • Critical listening, thinking, and problem resolution skills • Ability to manage multiple initiatives and prioritize goals • None required for licensure and certification • May be required to travel, estimated at less than 10%

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Equal Opportunity Employer environment fostering belonging and support for individuals of all backgrounds