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Payment Cycle Analyst III
Location
United States
Posted
9 days ago
Salary
$72.2K - $115.5K / year
Seniority
Senior
Job Description
Payment Cycle Analyst III
CareSource
• Conduct both systemic and targeted analysis to identify reimbursement errors and to determine root cause • Collaborate with Configuration, Configuration UAT, Enterprise UAT, IT Claims, and Payment Cycle Team members to ensure test scripts are comprehensive • Provide analytical support and leadership for special projects and initiatives related to reimbursement of claims for both providers and members • Research and provide recommendations to the Reimbursement Committee for reimbursement of services • Research claim results to determine potential errors/discrepancies attributed to clinical edits, claims coding, payment policies, and application of fee schedule and rates • Develop business requirements for payment decisions and manage the implementation process with Configuration, CES, IT and Market stakeholders • Lead special projects to ensure payment discrepancies are resolved and communicated to the appropriate parties • Provide payment expertise at provider meetings, Medicaid Fairs, market workgroups, and any other industry related events • Review and interpret regulatory items and policy manuals to ensure test scenarios support the requirements
Job Requirements
- Bachelor's degree required
- Five (5) years of health plan experience or equivalent experience with health plan operations and configuration required
- Experience with user testing required
- Experience with payment methodologies and industry pricers (ex: DRG, APC, SNF, RBRVS) preferred
- Advanced proficiency level experience in Microsoft Suite to include Word, Excel, PowerPoint, Access and Visio
- Strong computer skills and abilities in Facets or equivalent claim payment system is preferred
- Strong analytical skills with the ability to effectively communicate findings with the Leadership Team
- Demonstrated understanding of claims operations, configuration, and testing related to managed care
- Understanding of regression, unit, and user acceptance testing is required
Benefits
- Health insurance
- Bonifications tied to company and individual performance
- Total rewards package
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