Payment Cycle Analyst II

Payment Cycle Analyst II

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 system
• Conduct 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 rates
• Conduct both systemic and targeted analysis to identify reimbursement errors and determine root cause
• Ensure 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 results
• Create 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 Managers
• Document the status of open issues, configuration design, and final resolution
• Review and interpret regulatory items, timely delivery of required updates
• Provide support of system change policy initiatives, provide updates in payment policy meetings, and present to stakeholders
• Monitor configuration and Claim SOPs to ensure accuracy of claim payments
• Assist in the development of policies and procedures for claims processing, COB, appeals and adjustment functions
• Ensure payment policies and decisions are documented and collaborate with the Health Partner team to ensure information is included in provider education activities
• Perform any other job duties as requested

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

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 (hourly / salary) : Salary

Organization Level Competencies :

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.