Intelligence Analyst
IEHP
SQLTableau
Operations Specialist II
CareSource
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $61,500 - $98,400 per year
Job Level
JuniorMid-Level
Tech Stack
SQL
About the role
- The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects.
- Essential Functions: Represent claims on cross-functional project work teams
- Submit, monitor and prioritize IT tickets for the Claims department
- Review special projects and identify issue trends and potential resolutions
- Assist with Onbase reporting and processes
- Develop and draft P&P’s and job aides for Claims
- Assist in training claims staff on claims processing policy and procedures
- Assist in educating/training Business Partners on claims functions
- Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data.
- Perform analysis of all claims data in order to provide decision support to Claims management team
- Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues
- If assigned to Research and Resolution team, responsibilities include: Represent Claims Department at requested provider calls and visits
- Provide feedback and/or face-to-face interaction with providers for claims research and resolution
- Responsible for research and resolution of claims issues for all assigned provider inquiries and submissions
- Responsible for managing provider issues adhering to Workflow processes and tools (Facets and Onbase)
- Provide input for claims business requirements, testing processes and implementation tasks and plans
- Perform any other job related instructions, as requested
Requirements
- Bachelor’s degree or equivalent years of relevant work experience required
- Minimum of two (2) years of healthcare claims environment is required
- FACETS claims processing experience highly preferred
- SQL experience preferred
- Advanced level experience in Microsoft Word, Excel and PowerPoint
- Data analysis and trending skills
- Demonstrated understanding of claims operations specifically related to managed care
- Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
- Ability to work independently and within a team environment
- Attention to detail
- Familiarity of the healthcare field
- Critical listening and thinking skills
- Negotiation skills/experience
- Strong interpersonal skills
- Proper grammar usage
- Technical writing skills
- Time management skills
- Strong communication skills, both written and verbal
- Customer service orientation
- Decision making/problem solving skills
