Claims Management Analyst III at CareSource

Job Summary:The Claims Management Analyst III is responsible for leading eBusiness initiatives and coordination of activities across multiple functional areas.Essential Functions:Manage the EDI (Electronic Data Interchange) trading partners and network of clearinghouses to ensure accurate and timely exchange of informationWorks closely with Vendor Management to improve and maintain the trading partner agreement with the trading partners. This includes cost reduction and adding servicesDevelop and maintain a partnership with the trading partner account representativesManage trading partner performance, establish and monitor service level agreements, regulatory requirements, and contractual metricsProvide Subject Matter Expertise (SME) to all departments regarding eBusiness specific EDI transactionsBuild, sustain and leverage relationships to constantly allow for continuous improvement of the EDI business processResponsible for eBusiness EDI requirements that support regulatory, compliance, and business needs And eBusiness EDI regulatory reportingProvide critical reporting and analysis of functional performance, and make recommendations for enhancements, cost savings initiatives and process improvementsReview and analyze the effectiveness and efficiency of existing processes and systems, and participate in development of solutions to improve or further leverage these functionsParticipate in the process of estimating initiative budgets as well as developing business cases and tracking the benefitsUnderstand business strategy, define and lead eBusiness initiatives such as working with IT and others internal departments to automate functionsUnderstand the process to receive claims, claims rejections and denial processes, claims payment methodologies, adjudication processing, and Encounters to enable synergies among It and business groupsContribute to and/or develop user stories or provide user story guidance for sprint planningDevelop, document and perform testing and validation as neededDevelop and maintain an in-depth knowledge of the company's business and regulatory environmentsIdentify issues, risks, and mitigation opportunitiesPerform any other job duties as requestedEducation and Experience:Bachelor's degree or equivalent years of relevant work experience is requiredMinimum of five (5) years of health care operations experience in insurance, managed care, or related industry is requiredCompetencies, Knowledge and Skills:Advanced knowledge of healthcare EDI files (837, 277CA, 999, 270/271, 276/277, etc.)Advanced computer skillsDemonstrated exceptional communication (verbal and written) and high level of professionalismData analysis and trending skills to include query writing Knowledge of Claims IT processes and systemsWorking knowledge of managed care and health claims processingAbility to effectively interact with all levels of management within the organization and across multiple organizational layersDemonstrates excellent analysis, collaboration skills, facilitation and presentation skillsStrong interpersonal, leadership and relationship building skillsDecision making and problem solving skillsAbility to work independently and within a team environmentTime management skills; capable of multi-tasking and prioritizing workAttention to detailEffective decision making / problem solving skillsCritical thinking and listening skillsLicensure and Certification:NoneWorking Conditions:General office environment; may be required to sit or stand for extended periods of timeCompensation Range:$70,800.00 - $113,200.00 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: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-RW1