CareSource

Configuration Systems Analyst III, Pricing, Networx, SQL

CareSource

full-time

Posted on:

Origin:  • 🇺🇸 United States

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Salary

💰 $81,400 - $130,200 per year

Job Level

Mid-LevelSenior

Tech Stack

SQL

About the role

  • The Configuration Systems Analyst III is responsible for managing and defining system configuration requirements.
  • Essential Functions: Manage and define system configuration requirements. Responsibility for requirements, definition, document, design, testing, training and implementation support using appropriate templates or analysis tool
  • Develop and utilize reports to analyze and stratify data in order to address gaps and provide answers to issues identified within the department or by other departments
  • Identify, manage and document the status of open issues, configuration design, and final resolution within change management system
  • Review and interpret regulatory items, timely delivery of required updates
  • Development of standard code set and reimbursement design templates
  • Plan and implement new software releases including testing and training
  • Participate in meetings with business owners, users and IT to achieve solutions that meet the requirements and expectation of CareSource
  • Lead configuration initiatives in payment policy meetings and present to committees
  • Coordinate annual benefit changes with internal resources
  • Provide analysis of efficiencies related to system enhancement and automation.
  • Review, analyze, and document effectiveness and efficiency of existing systems and develop strategies for improving or further leveraging systems
  • Manage the reimbursement review. Identify and design appropriate changes.
  • Lead the development and execution of test plans and scenarios for all reimbursement designs for core business system and related processes
  • Audit configuration to ensure accuracy and internal controls to minimize fraud and abuse and overpayment related issues
  • Anticipate and identify customer needs and match products and services to facilitate the fulfillment of those needs
  • Ensure system processes and documents exist as basis for system logic
  • Manage resources and communications to facilitate work completion
  • Mentor the use of tools to define requirements
  • Perform any other job duties as requested

Requirements

  • High School Diploma or GED
  • Bachelor's degree or equivalent years of relevant work experience is preferred
  • A minimum of five (5) years of health plan experience, to include three (3) years of configuration or clinical editing software experience is required
  • Exposure to Facets or equivalent system is preferred
  • Exceptional computer skills and abilities in Facets
  • Advanced proficiency Microsoft Suite to include Word, Excel, Access and Visio
  • Proven understanding of database relationships required
  • Understanding of DRG and APC reimbursement methods
  • Understanding of CPT, HCPCs and ICD-CM Codes
  • Knowledge of HIPAA Transaction Codes
  • Effective listening and critical thinking skills
  • Effective problem solving skills with attention to detail
  • Excellent written and verbal communication skills
  • Ability to work independently and within a team environment
  • Strong interpersonal skills and high level of professionalism
  • Ability to develop, prioritize and accomplish goals
  • Understanding of the healthcare field and knowledge of Medicaid and Medicare
  • Proper medical coding knowledge and claims processing skills
  • Customer service oriented
  • Facets knowledge/training
  • Ability to manage vendor relationships