Configuration Analyst III, Facets, Automation experience
CareSource
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $81,400 - $130,200 per year
Job Level
Mid-LevelSenior
Tech Stack
PythonSQLVBA
About the role
- 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 is required
- 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
- Knowledge of coding languages (e.g. VBA, SQL, Python, C++, etc.)
- 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
- Proper medical coding knowledge and claims processing skills
- Customer service oriented.
Benefits
- health insurance
- retirement plans
- paid time off
- flexible work arrangements
- professional development
- bonuses
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
system configurationdata analysisregulatory interpretationcoding languagestest plansreimbursement designaudit configurationdatabase relationshipsmedical codingclaims processing
Soft skills
communicationleadershipmentoringcustomer serviceproblem-solvingorganizational skillscollaborationanalytical thinkingattention to detailadaptability
Certifications
High School DiplomaGEDBachelor's degree