CareSource

Compensation

Full Description

Job Description: • Leads and defines system requirements associated with Member Benefits, Provider Reimbursement and payment systems • Identify, manage and document the status of open issues • Develop and utilize reports to analyze and stratify data • Plan/implement new software releases including testing and training • Serve as liaison between IT and business areas • Lead review of benefits or provider reimbursement • Lead in the development and execution of test plans and scenarios • Audit configuration to ensure accuracy and minimize fraud and abuse Requirements: • High School Diploma or GED is required • Bachelor’s Degree or equivalent years of relevant work experience is preferred • Minimum of three (3) years health plan experience • Two (2) years of configuration or clinical editing software experience is required • Exposure to Facets is preferred • Advanced computer skills with Microsoft Word, Excel, Access, Visio and abilities in Facets • 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 • Critical listening and thinking skills • Decision making/problem solving skills • Customer service oriented • Facets knowledge/training • Proper claim coding knowledge Benefits: • Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development • Bonuses