Healthcare Reimbursement Analyst

Job Summary:

The Claims Reimbursement Analyst is responsible to support Claims Operations work including, implementation and management of product reimbursement strategy and process.

Essential Functions:

• Execute and support the tasks to develop, implement and maintain reimbursement guidelines for assigned CareSource Products, driving consistency, compliance, simplicity and standardization
• Collaborate with key stakeholders and Product to ensure Claims Reimbursement process and procedures align with the overall strategy and align to industry standard
• Participate in Benefit Interpretation support, including applicable grids, spreadsheets, and/or other technology based applications
• Support required legislative and regulatory reviews, as assigned
• Support required reimbursement material reviews for Claims, as required/assigned
• Participate in team meetings to establish and execute on detailed tasks
• Participate and lead initiatives, and have familiarity with, and demonstrated understanding of, CareSource products
• Complete tasks to support issue resolution and escalation
• Assist in the tasks to support the established budgets, timelines (milestones) and task schedules
• Assist in development of reports as required by internal stakeholders
• Support the identification and management of risk including implementing mitigation strategies and communicating/escalating to key stakeholders
• Execute assigned tasks to collaborate with senior leadership to ensure initiatives are properly funded, resourced, and managed, as assigned
• Lead initiatives and have familiarity with, and demonstrated understanding of CareSource’s Products
• Assist in development of reports as required by external governing bodies and internal stakeholders
• Support and execute published Claims related Policy & Procedures, detailed reports, and business decision documents to support the Claims function
• Provide clarification/verification for all levels regarding status/details
• Support the identification of technology-based solutions to support and continuously improve Claims accuracy, quality, and execution
• Provide guidance, support, and training to Claims and Operations
• Perform any other job duties as requested

Education and Experience:

• Bachelor of Arts/Science degree in Finance, Business or health care field, or other related field, or equivalent years of relevant work experience is required
• Minimum of three (3) years of product management, reimbursement policy creation, or claims experience is required
• Healthcare insurance industry experience, commercial or market place experience required.
• Familiarity of the healthcare/managed care field and knowledge of government program products is required
• Previous experience working with state and Federal regulators/government in a managed care setting is preferred

Competencies, Knowledge and Skills:

• Commitment to the mission and values of the CareSource Family of Companies
• Advanced proficiency level with Microsoft Office Suite (i.e. Microsoft Word, Excel, and PowerPoint)
• Responsive to a changing, fast paced/high-growth business environment, in a matrixed organization, with a demonstrated ability to execute
• High detail orientation skills
• Demonstrated excellent analysis, organizational and analytic skills
• Effective written and verbal communication skills
• Cross-functional team skills with strong interpersonal and relationship building skills
• Ability to work independently and within a team environment in a positive and supportive manner
• Ability to multi-task and prioritize work to meet project deadlines
• Critical listening and thinking skills
• Time management skills
• Display a customer service, member/provider-focused orientation
• Decision making/problem solving skills
• Strong planning, negotiating, and influencing skillset

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Ability to travel as required by the needs of the business