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CareSource · 4 hours ago

Payment Cycle Analyst II- Must Reside in Nevada! - R10881

Nevada, United States

Full-time

Onsite

Mid Level

$63K/yr - $100K/yr

3+ years exp

CareSource is a healthcare company focused on improving health outcomes. They are seeking a Payment Cycle Analyst II to provide analytical support for claims-related projects, ensuring compliance with clinical and payment policies while conducting thorough analyses to identify reimbursement errors.

Health CareMedicalNon Profit

Comp. & Benefits

H1B Sponsor Likely

Responsibilities

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

Qualification

Claims operations understandingClinical editing softwareData analysis skillsMicrosoft Suite proficiencyCPTHCPCsICD CodesHIPAA Transaction CodesCustomer service orientationHealthcare knowledgeCMS guidelinesReporting packages familiarityGoal prioritizationEffective listeningProblem solvingWritten communicationInterpersonal skillsPresentation skillsTeamworkAttention to detail

Required

Bachelor's degree or equivalent years of relevant work experience is required

Minimum of three (3) years of health plan experience is required or equivalent experience with provider coding and claim payment policies

Advanced proficiency level experience in Microsoft Suite to include Word, Excel, Access and Visio

Strong computer skills and abilities in Facets

Demonstrated understanding of claims operations, configuration, and clinical editing specifically related to managed care

Understanding of CPT, HCPCs and ICD-CM Codes, including strong working knowledge of Codes sets ICD-9/ICD-10, CPT, HCPC, REV, DRG and Rug

Knowledge of HIPAA Transaction Codes

Effective listening and critical thinking skills

Effective problem solving skills with attention to detail

Data analysis and trending skills

Excellent written and verbal communication skills

Ability to work independently and within a team environment

Strong interpersonal skills and high level of professionalism

Ability to develop, prioritize and accomplish goals

Understanding of the healthcare field and knowledge of Medicaid and Medicare

Customer service oriented with strong presentation skills

Strong working knowledge of claims processing edits and logic

Familiar with CMS guidelines / HIPPA and Affordable Care Act

Familiarity with reporting packages and running system reports

Preferred

Experience working with clinical editing software is preferred

Certified Medical Coder preferred

Benefits

You may qualify for a bonus tied to company and individual performance.

A substantial and comprehensive total rewards package.

Company

CareSource

Glassdoor3.8

CareSource provides managed care services to Medicaid beneficiaries.

Founded in 1989

Dayton, Ohio, USA

1001-5000 employees

https://www.caresource.com/

H1B Sponsorship

CareSource has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (30)

2024 (39)

2023 (35)

2022 (21)

2021 (37)

2020 (28)