Payment Cycle Analyst II- Must Reside in Nevada! at CareSource

Job Summary:The Payment Cycle Analyst II is responsible for providing analytical support and leadership for key Claims-related projects and initiatives.Essential Functions:Define clinical and payment policy requirements to support configuration of clinical editing systemConduct and research potential new reimbursement policy claim edits, including sourcing support, data analysis, consistency with Market regulatory requirements, and network impact.Research claim results to determine potential errors/discrepancies attributed to clinical edits, claims coding, payment policies, and application of fee schedule and ratesConduct both systemic and targeted analysis to identify reimbursement errors and determine root causeEnsure that all clinical and payment policy analysis and documentation is prepared, reviewed, and approved prior to implementation.Provide input to UAT and conduct post production validation of implementation resultsCreate effective written and oral communication materials that summarize findings and support fact based recommendations that can be shared with providers, provider associations, and Health Partner ManagersDocument the status of open issues, configuration design, and final resolutionReview and interpret regulatory items, timely delivery of required updatesProvide support of system change policy initiatives, provide updates in payment policy meetings, and present to stakeholdersMonitor configuration and Claim SOPs to ensure accuracy of claim paymentsAssist in the development of policies and procedures for claims processing, COB, appeals and adjustment functionsEnsure payment policies and decisions are documented and collaborate with the Health Partner team to ensure information is included in provider education activitiesPerform any other job duties as requestedEducation and Experience:Bachelor's degree or equivalent years of relevant work experience is requiredMinimum of three (3) years of health plan experience is required or equivalent experience with provider coding and claim payment policiesExperience working with clinical editing software is preferredCompetencies, Knowledge and Skills:Advanced proficiency level experience in Microsoft Suite to include Word, Excel, Access and VisioStrong computer skills and abilities in FacetsDemonstrated understanding of claims operations, configuration, and clinical editing specifically related to managed careUnderstanding of CPT, HCPCs and ICD-CM Codes, including strong working knowledge of Codes sets ICD-9/ICD-10, CPT, HCPC, REV, DRG and RugKnowledge of HIPAA Transaction CodesEffective listening and critical thinking skillsEffective problem solving skills with attention to detailData analysis and trending skillsExcellent written and verbal communication skillsAbility to work independently and within a team environmentStrong interpersonal skills and high level of professionalismAbility to develop, prioritize and accomplish goalsUnderstanding of the healthcare field and knowledge of Medicaid and MedicareCustomer service oriented with strong presentation skillsStrong working knowledge of claims processing edits and logicFamiliar with CMS guidelines / HIPPA and Affordable Care ActFamiliarity with reporting packages and running system reportsLicensure and Certification:Certified Medical Coder preferredWorking Conditions:General office environment; may be required to sit or stand for extended periods of timeOccasional travel (up to 10%) to attend meetings, training, and conferences may be required Compensation Range:$61,500.00 - $98,400.00 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:SalaryCompetencies:- Fostering a Collaborative Workplace Culture- Cultivate Partnerships- Develop Self and Others- Drive Execution- Influence Others- Pursue Personal Excellence- Understand the BusinessThis 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-TS1