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Configuration Analyst III - Benefits

Company: CareSource
Location: Dayton
Posted on: September 17, 2020

Job Description:

Requisition Number 20-0620 Post Date 7/22/2020 Title Configuration Analyst III - Benefits City Dayton State OH DescriptionRole and Responsibility:


  • Manage and define system configuration requirements. Responsibility for requirements, definition, document, design, testing, training and implementation support using appropriate templates or analysis tool

  • Develop and utilize reports to analyze and stratify data in order to address gaps and provide answers to issues identified within the department or by other departments

  • Identify, manage and document the status of open issues, configuration design, and final resolution within change management system

  • Review and interpret regulatory items, timely delivery of required updates
  • Development of standard code set and reimbursement design templates
  • Plan and implement new software releases including testing and training
  • Participate in meetings with business owners, users and IT to achieve solutions that meet the requirements and expectation of CareSource Lead configuration initiatives in payment policy meetings and present to committees

  • Coordinate annual benefit changes with internal resources
  • Provide analysis of efficiencies related to system enhancement and automation. Review, analyze, and document effectiveness and efficiency of existing systems and develop strategies for improving or further leveraging systems

  • Manage the reimbursement review. Identify and design appropriate changes. Lead the development and execution of test plans and scenarios for all reimbursement designs for core business system and related processes

  • Audit configuration to ensure accuracy and internal controls to minimize fraud and abuse and overpayment related issues

  • Anticipate and identify customer needs and match products and services to facilitate the fulfillment of those needs

  • Ensure system processes and documents exist as basis for system logic
  • Manage resources and communications to facilitate work completion
  • Mentor the use of tools to define requirements
  • Perform any other job related instructions as requested

    RequirementsEducation / Experience:


    • High School Diploma or GED is required
    • Bachelor's degree or equivalent years of relevant work experience is preferred






      • A minimum of five (5) years of health plan experience, to include three (3) years of configuration or clinical editing software experience is required

      • Exposure to Facets or equivalent system is preferred

        Required Competencies / Knowledge / Skills:


        • Exceptional computer skills and abilities in Facets
        • Advanced proficiency Microsoft Suite to include Word, Excel, Access and Visio

        • Proven understanding of database relationships required
        • Understanding of DRG and APC reimbursement methods
        • Understanding of CPT, HCPCs and ICD-CM Codes
        • Knowledge of HIPAA Transaction Codes
        • Effective listening and critical thinking skills
        • Effective problem solving skills with attention to detail Excellent written and verbal communication skills Ability to work independently and within a team environment

        • Strong interpersonal skills and high level of professionalism
        • Ability to develop, prioritize and accomplish goals
        • Understanding of the healthcare field and knowledge of Medicaid and Medicare
        • Proper medical coding knowledge and claims processing skills
        • Customer service oriented
        • Facets knowledge/training
        • Ability to manage vendor relationships

          Licensure / Certification:


          • Certified Medical Coder (CPC) is preferred

            Working Conditions:


            • General office environment, may be required to sit/stand for long periods of time



              #LI-RW1

              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.

Keywords: CareSource, Dayton , Configuration Analyst III - Benefits, Professions , Dayton, Ohio

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