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CareSource · 1 week ago

Configuration System Analyst II - Facets and Benefits Configuration is a must

United States

Full-time

Remote

Mid Level

$65K/yr - $104K/yr

3+ years exp

CareSource is a healthcare management organization, and they are seeking a Configuration System Analyst II to lead and define system requirements associated with Member Benefits and Provider Reimbursement. The role involves managing issues, analyzing data, planning software releases, and serving as a liaison between IT and business areas.

Health CareMedicalNon Profit

Comp. & Benefits

H1B Sponsor Likely

Responsibilities

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

Qualification

FacetsConfiguration softwareHealth plan experienceDatabase relationshipsCPTHCPCsICD-CM CodesHIPAA Transaction CodesMicrosoft WordMicrosoft ExcelMicrosoft AccessMicrosoft VisioClaims processingCustomer serviceProper grammar usageProper phone etiquetteAttention to detailTime managementCommunication skillsProblem solvingTeamwork

Required

High School Diploma or GED

Minimum of three (3) years health plan experience, to include two (2) years of configuration or clinical editing software experience

Advanced computer skills with Microsoft Word, Excel, Access, Visio and abilities in Facets

Proven understanding of database relationships

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

Preferred

Bachelor's Degree or equivalent years of relevant work experience

Exposure to Facets

Broad understanding of business considerations and functionality

Certified Medical Coder (CPC)

Benefits

You may qualify for a bonus tied to company and individual performance.

Substantial and comprehensive total rewards package.

Company

CareSource

Glassdoor3.8

CareSource provides managed care services to Medicaid beneficiaries.

Founded in 1989

Dayton, Ohio, USA

1001-5000 employees

https://www.caresource.com/

H1B Sponsorship

CareSource has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (30)

2024 (39)

2023 (35)

2022 (21)

2021 (37)

2020 (28)