CareSource

Compensation

Full Description

Job Description: • Implement optimization opportunities for prepay and post pay medical record auditing procedures and processes improvement auditing timeliness and quality outcomes • Oversee and ensure that supporting business and regulatory processes and documentation exists and kept current • Track and communicate production issues and escalations to ensure proper follow-up and coordination • Maintain project plans for all projects in which configuration is involved and ensure proper completion of those plans and escalation where timeframes will be changed • Lead new product and new vendor implementations to ensure timeliness and quality of new implementations • Develop and implement ticket controls and ensure that proper communication and approvals are in place prior to system implementation • Oversight and management of team of medical record coding auditors • Analyze and make a determination of appropriate reimbursements and/or modifications of Coding review guidelines in partnership with medical directors and clinical staff. Requirements: • Bachelor’s degree or equivalent years of relevant work experience is required • Minimum of five (5) years of experience in medical policy is required • Minimum of five (5) years of management experience is required • Health plan experience is required • Facets and clinical editing system or equivalent system experience is required • Advanced computer skills and abilities in Facets • Proficient in Microsoft Suite to include, Word, Excel, and Access • Knowledge of regulatory reporting and compliance requirements Benefits: • Bonuses tied to company and individual performance • Substantial and comprehensive total rewards package