Operations Associate
Wynd Labs
Operations Specialist III
CareSource
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $70,800 - $113,200 per year
Job Level
Mid-LevelSenior
About the role
- Provides analytical support and leadership for key Claims-related projects
- Regulatory reporting such as CMS and Medicaid Prompt Pay
- Serve as high dollar claims reviewer
- Identify payment integrity issues with claims reimbursement methodologies
- Prepare and deliver responses to legal correspondence and state complaints
- Provide Claims Subject Matter Expertise (SME) for cross-functional meetings including operational and new business implementation
- Act as primary Claims Representative and SME for corporate projects
- Act as primary Claims Representative on external audits
- Assist in development of policies and procedures for claims processing, COB, appeals and adjustment functions
- Lead Claims initiatives such as working with IT and others to automate claim functions; improve front end paper claim process; and report development with SIS
- Contribute to and/or develop user stories or provide user story guidance for sprint planning
- Implement new business including the design, testing and delivery of supporting processes to the business
- Perform any other job related instructions, as requested
Requirements
- Bachelor’s degree or equivalent years of relevant work experience required
- Minimum of five (5) years of healthcare claims environment, equivalent managed care, healthcare operations or professional industry experience
- Advanced proficiency level experience in Microsoft Word, Excel and PowerPoint
- Data analysis and trending skills
- Work with accumulators
- 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
- Effective communication skills
- Strategic management skills
- Ability to work independently and within a team environment
- Attention to detail
- Critical listening and thinking skills
- Negotiation skills/experience
- Technical writing skills
- Time management skills
- Decision making/problem solving skills
- Licensure and Certification: None
Benefits
- Remote
- In addition to base compensation, you may qualify for a bonus tied to company and individual performance.
- We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
data analysisclaims reimbursement methodologiesCPT codingICD-9 codingICD-10 codingHCPCS codingclaims processinguser storiesreport developmentMicrosoft Excel
Soft skills
effective communicationstrategic managementattention to detailcritical thinkingnegotiationtechnical writingtime managementdecision makingproblem solvingability to work independently
