Payment Cycle Analyst IV

AnalystAnalystFull TimeRemoteLeadTeam 1,001-5,000Since 30+ yearsH1B SponsorCompany SiteLinkedIn

Location

United States

Posted

7 days ago

Salary

$83K - $132.8K / year

Seniority

Lead

Bachelor Degree7 yrs expEnglish

Job Description

Payment Cycle Analyst IV

CareSource

• Payment Cycle Analyst IV is responsible for conducting both systemic and targeted analysis to identify reimbursement errors and to determine root cause. • Collaborating with Configuration, Configuration UAT, Enterprise UAT, IT Claims, and Payment Cycle Team members to ensure test scripts are comprehensive. • Proactively collaborates with various teams to support contracting implementations and resolution of complex claims issues. • Validate MCA Tests for expected results and communicate information to Reimbursement Analysts and HP Managers for provider notification. • Create effective written and oral communication materials that summarize findings and support fact-based recommendations

Job Requirements

  • Bachelor’s degree or equivalent years of relevant work experience is required
  • Minimum of seven (7) years of health plan experience is required or equivalent experience with health plan operations and configuration
  • Experience with user testing is required
  • Experience with payment methodologies and industry pricers (ex: DRG, APC, SNF, RBRVS) is preferred

Benefits

  • Bonuses tied to company and individual performance
  • Substantial and comprehensive total rewards package

Related Categories

Related Job Pages

More Analyst Jobs

Full TimeRemoteTeam 11-50H1B No Sponsor

• Support external customers with analyzing current business processes, developing business requirements, and documenting management processes and corresponding software requirements. • Provide Federal Financials subject matter expertise using Momentum Financials. • Requirements Elicitation: Collaborate with customers to facilitate structured discussions, refine business processes, and decompose complex requirements into Epics, Features, and actionable User Stories in a SAFe Agile environment. • Requirements Consolidation: Conduct reviews of existing requirements, artifacts and repositories and working with external customers to make needed updates. • Gap Analysis & Traceability: Map requirements to CGI’s Momentum Financials to determine which needs are met through configuration. Maintain the Requirements Traceability Matrix (RTM) from elicitation through testing and implementation. • Strategic Roadmapping: Assist in developing the Implementation Plan and Roadmap, identifying dependencies across system interfaces, data conversion, and federal reporting requirements. • Risk & Dependency Management: Proactively identify and log program risks. Perform Analysis of Alternatives (AoAs) for complex requirements and present recommendations to executive leadership.

District Of Columbia + 1 moreAll locations: District Of Columbia | Washington

Role Description Kickstart Your Career as an Entry-Level QA Analyst with Ace IT Careers! Ace IT Careers is seeking motivated individuals to join our team as Entry-Level QA Analysts. This role offers an excellent opportunity to build foundational skills in software quality assurance and testing while working remotely. Whether you are a recent graduate or looking to transition into the IT field, our comprehensive training program will prepare you for success in the QA industry. - Join us to gain hands-on experience. - Learn industry best practices. - Receive support for job placement with top tech companies. Qualifications - Bachelor’s degree in Computer Science, Information Technology, or related field preferred but not mandatory. - Open to beginners and individuals transitioning from other careers. - No prior experience necessary; training is provided. - Basic understanding of software development lifecycle and testing concepts. - Strong attention to detail and analytical thinking. - Effective communication skills, both written and verbal. - Familiarity with common computer applications such as Microsoft Office. Requirements - This role includes a paid training and evaluation period before placement. - Candidates must successfully complete the training program as part of the hiring process. - Training covers Manual Testing, Automation Testing, API testing, and CI/CD concepts. - Includes real-world project simulations and mock interviews to prepare for client requirements. Benefits - Health Care Plan (Medical, Dental & Vision) - Life Insurance (Basic, Voluntary & AD&D) - Paid Time Off (Vacation, Sick & Public Holidays) - Short Term & Long Term Disability - Training & Development - Work From Home

United States
Telligen logo

Population Health Data Quality Analyst

Telligen

Helping people live their healthiest lives by delivering true results for state/federal programs & health plan sponsors.

Analyst7 days ago
Full TimeRemoteTeam 501-1,000Since 1978H1B Sponsor

• Assess data sets for Medicare/Medicaid populations on dimensions such as accuracy, completeness, and duplication. • Identify and analyze the scope of data quality issues within Medicare/Medicaid claims data. • Resolve data quality issues promptly and effectively. • Develop and recommend procedures or best practices to prevent the reoccurrence. • Manage data within a relational database environment specific to Medicare/Medicaid populations. • Perform detailed analysis, including pattern analysis, of health care activities and projects. • Work collaboratively with cross-functional teams to support data-driven decision-making for Medicare/Medicaid healthcare quality programs.

District Of Columbia + 2 moreAll locations: District Of Columbia | Massachusetts | Washington
$72.8K - $113.0K / year
Job Closed
Tenpo logo

Analista de Plaft

Tenpo

Tenpo | Una cuenta muy tú. Ya somos más de 2.2MM de clientes, únete 🚀 💚.

Analyst7 days ago
Full TimeRemoteTeam 51-200H1B No Sponsor

• Ejecutar el proceso de monitoreo transaccional diario mediante las herramientas institucionales. • Analizar, documentar e investigar alertas, gestionando sus estados según los SLA definidos. • Aplicar controles de debida diligencia simplificada y reforzada según corresponda. • Escalar oportunamente al Oficial de Cumplimiento las alertas con indicios de Operaciones Sospechosas. • Realizar screening de PEPs, sanciones internacionales, listas negras, etc. • Monitorear diariamente la cartera de clientes con causas penales activas. • Realizar seguimiento semanal a clientes en etapa de onboarding con coincidencias en delitos para la investigación de condenas. • Gestionar el proceso de cierre de cuentas de clientes con evidencia de comportamiento delictual. • Elaborar reportes internos de operaciones sospechosas y apoyar en la preparación de los reportes regulatorios para la UAF. • Mantener actualizados los indicadores clave (KPIs) del proceso. • Apoyar en la confección del Comité de Cumplimiento, PLAFT y Ética, además de dar soporte al cliente interno. • Participar activamente en el diseño, implementación y seguimiento del nuevo sistema PLAFT del Banco. • Apoyar la ejecución de planes de acción derivados de auditorías internas o del regulador. • Proponer mejoras continuas al modelo PLAFT y apoyar en la aplicación de capacitaciones internas.

Chile