Job Location : Dayton,OH, USA
The Payment Cycle Analyst II is responsible for providing analytical support and leadership for key claims-related projects and initiatives. Essential functions include defining clinical and payment policy requirements to support the configuration of clinical editing systems, conducting and researching potential new reimbursement policy claims edits, and ensuring that all clinical and payment policy analysis and documentation is prepared, reviewed, and approved prior to implementation. The role also requires creating 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.
Competencies, knowledge, and skills include advanced proficiency in Microsoft Suite, strong computer skills in Facets, and a demonstrated understanding of claims operations, configuration, and clinical editing specifically related to managed care. The role requires effective listening and critical thinking skills, effective problem-solving skills with attention to detail, and excellent written and verbal communication skills.
Education and experience requirements include a bachelor's degree or equivalent years of relevant work experience, minimum of three years of health plan experience, and experience working with clinical editing software. Familiarity with CMS guidelines, HIPAA, and the Affordable Care Act is also required.
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 factors.