Job Summary :
The Configuration Systems Analyst III is responsible for managing and defining system configuration requirements.
Essential Functions :
- Manage and define system configuration requirements. Responsibility for requirements, definition, document, design, testing, training and implementation support using appropriate templates or analysis tool
- 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
- Identify, manage and document the status of open issues, configuration design, and final resolution within change management system
- Review and interpret regulatory items, timely delivery of required updates
- Development of standard code set and reimbursement design templates
- Plan and implement new software releases including testing and training
- Participate in meetings with business owners, users and IT to achieve solutions that meet the requirements and expectation of CareSource Lead configuration initiatives in payment policy meetings and present to committees
- Coordinate annual benefit changes with internal resources
- Provide analysis of efficiencies related to system enhancement and automation. Review, analyze, and document effectiveness and efficiency of existing systems and develop strategies for improving or further leveraging systems
- Manage the reimbursement review. Identify and design appropriate changes. Lead the development and execution of test plans and scenarios for all reimbursement designs for core business system and related processes
- Audit configuration to ensure accuracy and internal controls to minimize fraud and abuse and overpayment related issues
- Anticipate and identify customer needs and match products and services to facilitate the fulfillment of those needs
- Ensure system processes and documents exist as basis for system logic
- Manage resources and communications to facilitate work completion
- Mentor the use of tools to define requirements
- Perform any other job duties as requested
Education and Experience :
High School Diploma or GED is requiredBachelor's degree or equivalent years of relevant work experience is preferredA minimum of five (5) years of health plan experience, to include three (3) years of configuration or clinical editing software experience is requiredExposure to Facets or equivalent system is preferredCompetencies, Knowledge and Skills :
Exceptional computer skills and abilities in FacetsAdvanced proficiency Microsoft Suite to include Word, Excel, Access and VisioProven understanding of database relationships requiredUnderstanding of DRG and APC reimbursement methodsUnderstanding of CPT, HCPCs and ICD-CM CodesKnowledge of HIPAA Transaction CodesEffective listening and critical thinking skillsEffective problem solving skills with attention to detail Excellent written and verbal communication skills Ability 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 MedicareProper medical coding knowledge and claims processing skillsCustomer service orientedFacets knowledge / trainingAbility to manage vendor relationshipsLicensure and Certification :
Certified Medical Coder (CPC) is preferredWorking Conditions :
General office environment; may be required to sit or stand for extended periods of timeCompensation Range :
$81,400.00 - $130,200.00 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 : Salary
Competencies :
Fostering a Collaborative Workplace CultureCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand 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.
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