Provider Network Analyst II (Facets experience a must)

Job Summary:

The Provider Network Analyst II ensures operational effectiveness by assisting in strategic and business planning, including business, financial, and operational goals and objectives.

Essential Functions:

• Provide oversight to all new contracts to ensure that appropriate and timely claims system set up occurs and that rigorous testing yields appropriate outcome prior to payment methodology implementation
• Identify issues related to reimbursement and recommends appropriate solutions. Includes generating and analyzing queries or reports for analysis
• Analyze provider database to ensure data consistency and optimal database structure
• Takes a leading role in the review of reports and data for pattern identification, special cause variation identification, trend analysis, or other techniques; prepare and deliver summaries, recommendations, or alternatives of the analyzed information
• Serves as provider data representative in claims editing decisions and implementation and oversight of testing to ensure that it yields appropriate claims processing
• Assist in servicing key hospital or other designated providers in all lines of business, existing and future to ensure rapid diagnosis and resolution of complex claims issues
• Build and strengthen provider relationships by facilitating quality service
• Actively participate in operational calls with key providers or network partners as needed
• Proactively communicates technical system changes, claims processing, CareSource policies on reimbursement, take-back initiatives, and configuration
• Ensure all governing body regulations are adhered to at all times for existing and future lines of business
• Mentor internal resources to achieve cross-functional capability with project execution and subject matter expertise
• Perform any other job related duties as requested

Education and Experience:

• Bachelor of Science/Arts degree or equivalent years of relevant work experience is required
• Three (3) years of provider contracts; claims or configuration experience is required
• Five to eight (5-8) years of health care operations experience in insurance, managed care, or related industry is required

Competencies, Knowledge and Skills:

• Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint
• In depth knowledge of Facets
• Knowledge of performance/process improvement methodology highly desired
• Knowledge of provider, customer service and claims functions is required
• Demonstrates excellent analysis and collaboration skills
• Knowledge of claims payment processes
• Strong interpersonal, leadership and relationship building skills
• Ability to effectively interact with all levels of management within the organization and across multiple organizational layers
• Excellent written and verbal communication skills
• Effective listening and critical thinking skills
• Strong interpersonal skills and high level of professionalism
• Effective problem solving skills with attention to detail
• Ability to work independently and within a team environment
• Ability to develop, prioritize and accomplish goals

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

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:
Salary

Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

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 inclusive environment that welcomes and supports individuals of all backgrounds.

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