Payment Cycle Analyst III

Responsibilities

• Conduct systemic and targeted analysis to identify reimbursement errors and determine root causes
• Collaborate with Configuration, IT, and UAT teams to ensure comprehensive test scripts and successful implementation
• Research claim results to identify discrepancies related to clinical edits, coding, payment policies, and fee schedules
• Develop business requirements for payment decisions and manage the implementation process with stakeholders
• Lead special projects to resolve payment discrepancies and communicate findings to appropriate parties
• Review and interpret regulatory items and policy manuals to ensure test scenarios meet requirements
• Build and maintain a library of reusable test plans and scripts to support the market
• Validate Impact Reports and UAT test results prior to promoting changes to production
• Create written and oral communication materials to summarize findings for the Reimbursement Committee and leadership

Requirements

• Bachelor's degree or equivalent years of relevant work experience
• Five (5) years of health plan experience or equivalent experience with health plan operations and configuration
• Proven experience with user testing (regression, unit, and UAT)
• Strong working knowledge of claims processing edits and logic
• Advanced proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Access, and Visio)
• Strong analytical, problem-solving, and critical thinking skills

Preferred Qualifications

• Experience with payment methodologies and industry pricers such as DRG, APC, SNF, or RBRVS
• Strong computer skills and experience with Facets or an equivalent claim payment system
• Knowledge of Medicaid, Medicare, and Marketplace environments
• Familiarity with CMS guidelines, HIPAA, and the Affordable Care Act

About the Company

CareSource is a mission-driven organization dedicated to creating a better world for members, stakeholders, and providers. We combine compassionate care with business expertise to provide consumer-centric solutions and make every opportunity count for the communities we serve.