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Operations Specialist Ii Jobs

Company

CareSource
Address , Remote
Employment type FULL_TIME
Salary $58,000 - $92,800 a year
Expires 2023-07-16
Posted at 11 months ago
Job Description
Job Summary:
The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects.
Essential Functions:
  • Represent claims on cross-functional project work teams
  • Perform analysis of all claims data in order to provide decision support to Claims management team
  • Review special projects and identify issue trends and potential resolutions
  • 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
  • Perform any other job related instructions, as requested
  • Responsible for research and resolution of claims issues for all assigned provider inquiries and submissions
  • Assist in educating/training Business Partners on claims functions
  • Assist in training claims staff on claims processing policy and procedures
  • Provide feedback and/or face-to-face interaction with providers for claims research and resolution
  • Provide input for claims business requirements, testing processes and implementation tasks and plans
  • Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues
  • Represent Claims Department at requested provider calls and visits
  • Responsible for managing provider issues adhering to Workflow processes and tools (Facets and Onbase)
  • Develop and draft P&P’s and job aides for Claims
  • Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data.
  • Assist with Onbase reporting and processes
  • Submit, monitor and prioritize IT tickets for the Claims department
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:
  • Demonstrated understanding of claims operations specifically related to managed care
  • Attention to detail
  • Strong communication skills, both written and verbal
  • Time management skills
  • Advanced level experience in Microsoft Word, Excel and PowerPoint
  • Ability to work independently and within a team environment
  • Strong interpersonal skills
  • Customer service orientation
  • Decision making/problem solving skills
  • Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
  • Data analysis and trending skills
  • Technical writing skills
  • Proper grammar usage
  • Critical listening and thinking skills
  • Negotiation skills/experience
  • Familiarity of the healthcare field
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
  • Develop Self and Others
  • Understand the Business
  • Cultivate Partnerships
  • Create an Inclusive Environment
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence

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.