Operations Specialist II - R7300

Job Summary

The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects.

Essential Functions

Represent claims on cross-functional project work teamsSubmit, monitor and prioritize IT tickets for the Claims departmentReview special projects and identify issue trends and potential resolutionsAssist with Onbase reporting and processesDevelop and draft P&P’s and job aides for ClaimsAssist in training claims staff on claims processing policy and proceduresAssist in educating/training Business Partners on claims functionsResearch and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data.Perform analysis of all claims data in order to provide decision support to Claims management teamIdentify and quantify data issues within Claims and assist in the development of plans to resolve data issuesIf assigned to Research and Resolution team, responsibilities include:Represent Claims Department at requested provider calls and visitsProvide feedback and/or face-to-face interaction with providers for claims research and resolutionResponsible for research and resolution of claims issues for all assigned provider inquiries and submissionsResponsible for managing provider issues adhering to Workflow processes and tools (Facets and Onbase)Provide input for claims business requirements, testing processes and implementation tasks and plansPerform any other job related instructions, as requested

Education And Experience

Bachelor’s degree or equivalent years of relevant work experience requiredMinimum of two (2) years of healthcare claims environment is required

Competencies, Knowledge And Skills

Advanced level experience in Microsoft Word, Excel and PowerPointData analysis and trending skillsDemonstrated understanding of claims operations specifically related to managed careAdvanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS codingAbility to work independently and within a team environmentAttention to detailFamiliarity of the healthcare fieldCritical listening and thinking skillsNegotiation skills/experienceStrong interpersonal skillsProper grammar usageTechnical writing skillsTime management skillsStrong communication skills, both written and verbalCustomer service orientationDecision making/problem solving skills

Licensure And Certification

None

Working Conditions

General office environment; may be required to sit or stand for extended periods of time

Compensation Range

$60,300.00 - $96,500.00 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. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type

Salary