Configuration Analyst III (Must have Facets and Automation experience)

CareSource•Dayton, OH

About The Position

Job Summary: The Configuration Systems Analyst III is responsible for managing and defining system configuration requirements. Essential Functions: 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 duties as requested Education and 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 Competencies, Knowledge and Skills: Exceptional computer skills and abilities in Facets Knowledge of coding languages (e.g. VBA, SQL, Python, C++, etc.) 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 and Certification: Certified Medical Coder (CPC) is preferred Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation Range: $81,400.00 - $130,200.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business 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. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-GB1 The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.

Requirements

High School Diploma or GED is required
A minimum of five (5) years of health plan experience, to include three (3) years of configuration or clinical editing software experience is required
Exceptional computer skills and abilities in Facets
Knowledge of coding languages (e.g. VBA, SQL, Python, C++, etc.)
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

Nice To Haves

Bachelor’s degree or equivalent years of relevant work experience is preferred
Exposure to Facets or equivalent system is preferred
Certified Medical Coder (CPC) is preferred

Responsibilities

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 duties as requested