Market Liaison Resolution Specialist

Job Summary:

The Market Liaison Resolution Specialist is responsible for achieving resolution of Operational Intakes processed by the Market Liaison Support Services (MLSS) Research Team, ensuring root causes are thoroughly documented, ensuring Operational Intakes are effectively resolved, and impacted claims are appropriately adjusted, contributing to the overall efficiency and quality of operations within the organization.

Essential Functions:

• Conduct detailed reviews and document findings to achieve comprehensive resolutions for each intake, adhering to established change control protocols and Standard Operating Procedures.
• Collaborate with applicable departments, including contracting, credentialing, provider data management, claims, configuration, enrollment, utilization management, finance, payment integrity, policy, member benefits, IT and other operational/enterprise departments.
• Investigate all Market State Complaint tasks and provide timely, complete, accurate and concise documentation to compliance teams.
• Meet Service Level Agreements (SLA) consistently.
• Assess and generate reports to determine claim impact to aid in resolution.
• Ensure impacted claims are adjusted and assist in claims adjudication/adjusting when necessary following claims Standard Operating Procedures and other supporting documentation.
• Utilize critical thinking skills, discretion and independent judgment to determine best course of action for each inquiry/problem.
• Act as a subject matter expert for Market specifications and regulations, as they pertain to HPLC.
• Identify opportunities for operational and technical process improvements within HPLC.
• Participate in User Acceptance Training (UAT) of system issues identified during resolution of MLSS Operational intakes to ensure functionality meets operational needs.
• Lead or participate solution sessions with providers and the market when necessary, including supporting the provider or market via emails or internal/external phone communication.
• Communicate effectively with various internal departments to enhance cross-functional awareness, promote process improvement, and identify root cause resolution of issues.
• Build and maintain cross-functional working relationships with operational departments, markets, support partners, and other areas in which collaboration is essential for resolving issues and driving improvements.
• Assist the market proactively by evaluating risks and developing risk-mitigation actions.
• Performs any other job related duties as requested.

Education and Experience:

• Bachelor's degree required
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Two (2) years of experience in managed care operations required

Competencies, Knowledge and Skills:

• Knowledge of Medicaid/Medicare and familiarity of healthcare industry
• Overall understanding of Provider Contracting applications such Choreo or Cactus is preferred
• Facets knowledge
• Advanced troubleshooting and problem-solving capabilities with attention to detail
• Overall knowledge and understanding of Managed Care Operations-related systems, medical coding, technical specifications, and processes
• Strong critical thinking skills
• Ability to multi-task while dealing with several escalations
• Ability to analyze processes and develop clear recommendations for remediation
• Solid understanding of claims processing is required
• Thorough understanding of medical claim configuration
• Proficient in Microsoft Office Suite specifically Word and Excel
• Excellent verbal and written communication skills
• Effective relationship management skills
• Effective organization, time management, and prioritization skills
• Strong interpersonal skills and high level of professionalism

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Up to 15% (Occasional) travel based on the needs of the department may be required

Compensation Range:
$54,500.00 - $87,300.00 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 external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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