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CareSource · 2 days ago

REMOTE - Claims Management Analyst III - R10152

United States

Full-time

Remote

Mid, Senior Level

$72K/yr - $116K/yr

5+ years exp

CareSource is a healthcare company, and they are seeking a Claims Management Analyst III to lead eBusiness initiatives and coordinate activities across multiple functional areas. The role involves managing EDI trading partners, improving trading partner agreements, and providing subject matter expertise regarding EDI transactions.

Health CareMedicalNon Profit

Comp. & Benefits

Responsibilities

Manage the EDI (Electronic Data Interchange) trading partners and network of clearinghouses to ensure accurate and timely exchange of information

Works closely with Vendor Management to improve and maintain the trading partner agreement with the trading partners. This includes cost reduction and adding services

Develop and maintain a partnership with the trading partner account representatives

Manage trading partner performance, establish and monitor service level agreements, regulatory requirements, and contractual metrics

Provide Subject Matter Expertise (SME) to all departments regarding eBusiness specific EDI transactions

Build, sustain and leverage relationships to constantly allow for continuous improvement of the EDI business process

Responsible for eBusiness EDI requirements that support regulatory, compliance, and business needs And eBusiness EDI regulatory reporting

Provide critical reporting and analysis of functional performance, and make recommendations for enhancements, cost savings initiatives and process improvements

Review and analyze the effectiveness and efficiency of existing processes and systems, and participate in development of solutions to improve or further leverage these functions

Participate in the process of estimating initiative budgets as well as developing business cases and tracking the benefits

Understand business strategy, define and lead eBusiness initiatives such as working with IT and others internal departments to automate functions

Understand the process to receive claims, claims rejections and denial processes, claims payment methodologies, adjudication processing, and Encounters to enable synergies among It and business groups

Contribute to and/or develop user stories or provide user story guidance for sprint planning

Develop, document and perform testing and validation as needed

Develop and maintain an in-depth knowledge of the company’s business and regulatory environments

Identify issues, risks, and mitigation opportunities

Perform any other job duties as requested

Qualification

Healthcare EDI filesData analysisClaims IT processesManaged care knowledgeAdvanced computer skillsCommunication skillsProblem solving skillsTime managementCritical thinkingInterpersonal skills