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Remote - Operations Specialist Ii - R6272
Company | CareSource |
Address | United States |
Employment type | FULL_TIME |
Salary | |
Category | Insurance |
Expires | 2023-06-15 |
Posted at | 1 year ago |
Job Summary
The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects.
Essential Functions
$58,000.00 - $92,800.00
Compensation Type
Salary
The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects.
Essential Functions
- Responsible for managing provider issues adhering to Workflow processes and tools (Facets and Onbase)
- Represent claims on cross-functional project work teams
- Assist in training claims staff on claims processing policy and procedures
- Review special projects and identify issue trends and potential resolutions
- Perform analysis of all claims data in order to provide decision support to Claims management team
- Submit, monitor and prioritize IT tickets for the Claims department
- Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data.
- Assist in educating/training Business Partners on claims functions
- Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues
- Develop and draft P&P’s and job aides for Claims
- Assist with Onbase reporting and processes
- If assigned to Research and Resolution team, responsibilities include:
- 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
- Represent Claims Department at requested provider calls and visits
- Perform any other job related instructions, as requested
- Provide input for claims business requirements, testing processes and implementation tasks and plans
- Bachelor’s degree or equivalent years of relevant work experience required
- Minimum of two (2) years of healthcare claims environment is required
- Advanced level experience in Microsoft Word, Excel and PowerPoint
- Attention to detail
- Negotiation skills/experience
- Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
- Data analysis and trending skills
- Customer service orientation
- Proper grammar usage
- Demonstrated understanding of claims operations specifically related to managed care
- Time management skills
- Familiarity of the healthcare field
- Decision making/problem solving skills
- Technical writing skills
- Strong communication skills, both written and verbal
- Critical listening and thinking skills
- Ability to work independently and within a team environment
- Strong interpersonal skills
- None
- General office environment; may be required to sit or stand for extended periods of time
$58,000.00 - $92,800.00
Compensation Type
Salary
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