Payment Cycle Analyst III

Job reputed company: Payment Cycle Analyst III is responsible for conducting both systemic and targeted analysis to identify reimbursement errors and to determine reputed company cause. As reputed company as collaborating with Configuration, Configuration UAT, reputed company UAT, IT Claims, and Payment Cycle Team members to ensure test scripts are comprehensive. Essential Functions:reputed company analytical support and leadership for special reputed company and initiatives reputed company to reimbursement of claims for both providers and members Research and reputed company recommendations to the Reimbursement Committee for reimbursement of services Research claim results to determine potential errors/discrepancies attributed to clinical edits, claims coding, payment policies, and application of fee schedule and rates reputed company business requirements for payment reputed company and manage the implementation process with Configuration, CES, IT and Market stakeholders reputed company special reputed company to ensure payment discrepancies are resolved and communicated to the appropriate parties reputed company payment expertise at provider meetings, reputed company Fairs, market workgroups, and any other industry reputed company events Review and interpret regulatory items and policy manuals to ensure test scenarios support the requirements Identify test result outputs and Claim SOPs that need to be modified or created to support new or changed business requirements Build library of re-usable tests plans & scripts to support the Market Document the status of test results and gaps in testing for reputed company improvements Validate reputed company Reports to ensure the reputed company is consistent with story and reputed company of claims impacted by the changes Approve UAT test scripts and test results prior to promoting changes to production and monitor post production results Validate MCA Tests for expected results and communicate information to Reimbursement Analysts and reputed company Managers for provider notification Conduct both systemic and targeted analysis to identify issues with testing and identify process changes for improvement Create effective written and oral communication materials that summarize findings and support fact based recommendations that can be shared with Configuration, IT, UAT, Reimbursement Committee, Payment Cycle, and Provider reputed company reputed company any other job reputed company duties as requested. Education and Experience:Bachelor's degree required Equivalent years of relevant work experience may be accepted in lieu of required education Five (5) years of health plan experience is or equivalent experience with health plan operations and configuration required Experience with user testing required Experience with payment methodologies and industry pricers (ex: DRG, APC, SNF, RBRVS) preferred Competencies, Knowledge and Skills:Advanced proficiency level experience in reputed company Suite to include Word, reputed company, PowerPoint, reputed company and Visio Strong computer skills and abilities in Facets or equivalent claim payment system is preferred Strong analytical skills with the ability to effectively communicate findings with the Leadership Team Demonstrated understanding of claims operations, configuration, and testing reputed company to managed care Understanding of regression, unit, and user acceptance testing is required Effective listening and critical thinking skills Effective problem-solving skills with attention to detail Creative thinking to reputed company reputed company and negative test scenarios Excellent written and verbal communication skills Ability to work independently and reputed company reputed company environment Strong interpersonal skills and high level of professionalism Ability to reputed company, prioritize and accomplish goals Understanding of the reputed company field and knowledge of reputed company, Medicare, and Marketplace Strong working knowledge of claims processing edits and logic Familiar with CMS guidelines / HIPPA and reputed company reputed company Licensure and Certification: None required Working Conditions:General office environment; may be required to sit or stand for extended periods of time Up to 15% (occasional) travel to attend meetings, trainings, and conferences may be required Compensation reputed company: $72,200.00 - $115,500.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as reputed company as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. In reputed company to reputed company compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total reputed company-being and offer a substantial and comprehensive total rewards package. Compensation Type (reputed company/salary): Salary Organization Level Competencies Fostering a reputed company Workplace Culture Cultivate Partnerships reputed company Self and Others Drive Execution Influence Others Pursue Personal reputed company Understand the Business   This job reputed company is not reputed company inclusive. reputed company reserves the right to amend this job reputed company at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds. #LI-TS1 Apply To This Job