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Operations Specialist Ii- Implementation

Company

CareSource
Address , Remote
Employment type FULL_TIME
Salary $58,000 - $92,800 a year
Expires 2023-07-17
Posted at 11 months ago
Job Description
Job Summary:
Preferred work location is Dayton OH. Remote may be considered.
The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects with Implementation focus.
Essential Functions:
  • Lead implementation efforts for Claims new lines of business and project implementations
  • Create claim requirements for business requirement documents, user stories, and UAT
  • Represent claims as a Claims Processing SME on cross-functional project for new lines of business implementation
  • Understand any regulatory or contractual requirements for new project implementations
  • Responsible for managing provider issues adhering to Workflow processes and tools (Facets and Onbase)
  • Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues
  • Assist in training claims staff on claims processing policy and procedures
  • 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
  • Provide input for claims business requirements, testing processes and implementation tasks and plans
  • Review special projects and identify issue trends and potential resolutions
  • Represent Claims Department at requested provider calls and visits
  • Responsible for research and resolution of claims issues for all assigned provider inquiries and submissions
  • Represent claims on cross-functional project work teams
  • Perform analysis of all claims data in order to provide decision support to Claims management team
  • Provide feedback and/or face-to-face interaction with providers for claims research and resolution
  • Perform any other job-related instructions, as requested
  • Submit, monitor and prioritize IT tickets for the Claims department
  • Assist with Onbase reporting and processes
  • Develop and draft P&P’s and job aides for Claims
  • 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.
Education and Experience:
  • Bachelor’s degree or equivalent years of relevant work experience required
  • Minimum of two (2) years of healthcare claims environment is required
Competencies, Knowledge and Skills:
  • Strong communication skills, both written and verbal
  • Familiarity of the healthcare field
  • Critical listening and thinking skills
  • Ability to work independently and within a team environment
  • Strong interpersonal skills
  • Customer service orientation
  • 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
  • Proper grammar usage
  • Attention to detail
  • Time management skills
  • Decision making/problem solving skills
  • Data analysis and trending skills
  • Advanced level experience in Microsoft Word, Excel and PowerPoint
  • Technical writing skills
  • Negotiation skills/experience
Licensure and Certification:
  • None
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$58,000.00 - $92,800.00
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
  • Understand the Business
  • Develop Self and Others
  • Pursue Personal Excellence
  • Drive Execution
  • Cultivate Partnerships
  • Influence Others
  • Create an Inclusive Environment

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.