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