Configuration System Analyst II Benefits Configu

Job description

Job Summary:
The Configuration Systems Analyst II Leads and defines system requirements associated with Member Benefits, Provider Reimbursement and payment systems requirements definition, documentation, design, testing, training and implementation support using appropriate templates or analysis tools.

Essential Functions:
Identify, manage and document the status of open issues.

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, utilizing TriZetto or Optum for research and correction.
Utilize available tools provided by relevant State or Federal websites to obtain pertinent Fed/State Regulatory Transmittals and Fee Schedules.
Plan/implement new software releases including testing and training.
Participate in meetings with business owners and users to achieve a Plan benefit design and Provider Reimbursement.

Serve as liaison between IT and business areas to research requirements for IT projects, meet with decision makers to translate IT specifications and define business requirements and system goals.
Lead review of benefits or provider reimbursement as well as identify and design appropriate changes.

Lead in the development and execution of test plans and scenarios for all benefit or reimbursement designs and for the core business system and related processes.
Provides detail analysis of efficiencies related to system enhancement/automation.

Review, analyze, and document the effectiveness and efficiency of existing systems and develop strategies for improving or further leveraging these systems.

Conduct preliminary studies to define needs and determine feasibility of system design.
Audit configuration to ensure accuracy and tight internal controls to minimize fraud and abuse and overpayment related issues.
Ensure system processes and documents exist as basis for system logic.
Assists in resolution for potential business risk, including communication and escalation as necessary.
Vendor management between TriZetto and CareSource.
Applies use of tools to define requirements such as data modeling, use case analysis, workflow analysis and functional analysis.
Perform any other job related instructions as requested

Education and Experience:
High School Diploma or GED is required
Bachelor's Degree or equivalent years of relevant work experience is preferred
Minimum of three (3) years health plan experience, to include two (2) years of configuration or clinical editing software experience is required
Exposure to Facets is preferred

Competencies, Knowledge and Skills:
Advanced computer skills with Microsoft Word, Excel, Access, Visio and abilities in Facets
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
Critical listening and thinking skills
Decision making/problem solving skills
Enhanced communication skills both written and verbal
Can work independently and within a team environment
Attention to detail
Understanding of the healthcare field
Knowledge of Medicaid/Medicare
Claims processing skills
Proper grammar usage
Time management skills
Proper phone etiquette
Customer service oriented
Facets knowledge/training
Proper claim coding knowledge
Ability to be telecommuter
Broad understanding of business considerations and functionality preferred

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:
$63,720.00 - $101,880.00 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 sala y 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:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the state and supported by CareSource's national leadership in quality and operational excellence.

TrueCare offers locally based provider services through provider engagement representatives and customer care.

Our sole mission is to improve the health of Mississippians by leveraging local physician experience to inform decision-making, aligning incentives, using data more effectively, and reducing friction between the delivery and financing of health care.

By doing so, TrueCare will change the way health care is delivered in Mississippi.
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.
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CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law.

Required Skill Profession

Other General