Provide analytical support and leadership for Claims Encounters Regulatory Data projects
Responsible for reviewing Encounter rejections and providing resolution of minor to complex data issues or process changes
Provide Claims Encounter Subject Matter Expertise (SME) for both CMS and State agencies and internal CareSource impacted organizations (IT, Claims, New Business, Enrollment, etc.)
Build, sustain and leverage relationships with persons within his/her responsibility to constantly allow for continuous improvement of the Encounter Data business process
Direct responsibility for the design, testing and delivery of supporting processes to the business
Lead the claims data processes to ensure accuracy and compliance with CMS and state agencies
Requirements
Bachelor’s degree or equivalent years of relevant work experience is required
Minimum of five (5) years of managed healthcare, claims, or managed care regulated environment experience is required
Minimum of five (5) years of experience using at least two of the following tools is required: SQL, SAS, SSIS, MySQL, ORACLE, R, or PowerBI
Benefits
Comprehensive total rewards package
Bonus tied to company and individual performance
Applicant Tracking System Keywords
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