Data-Driven Claims Reimbursement Analyst II

CareSource; Ohio; Ibrido; USD 63.000 - 100.000; Tempo pieno

Descrizione del lavoro

CareSource in Ohio is seeking a Claims Reimbursement Analyst II to perform reimbursement analysis that supports accurate claims payment and contract compliance. You will analyze outcomes, identify variances, and assist with configuration, testing, and process improvement activities.

You will collaborate with Claims, Configuration, Provider Contracting, Provider Analytics, and Operations to ensure reimbursement practices align with contracts, fee schedules, and industry standards, while using

Competenze

• Bachelor’s degree in Business, Healthcare Administration, Finance, Analytics, or a related field is required.
• Three (3) years of product management, reimbursement policy creation, or claims experience required.
• Two (2) years of healthcare reimbursement, claims analysis, or payment operations required.
• Familiarity of the healthcare/managed care field and knowledge of government program products preferred.

Mansioni

• Develop, implement, and maintain reimbursement guidelines for assigned CareSource products to promote consistent, compliant, simple, and standardized Claims Reimbursement processes.
• Collaborate with product owners and cross-functional partners to align reimbursement processes with contracts, fee schedules, reimbursement methodologies, and industry standards.
• Support Benefit Interpretation activities using grids, spreadsheets, and technology-based applications.
• Analyze reimbursement outcomes, payment data, and implementation results to identify discrepancies and variances across claims, providers, and products.
• Perform root-cause analysis, document findings, and recommend corrective actions for issue resolution.

Conoscenze

Healthcare reimbursement

Claims analysis

Analytical thinking

Communication

Formazione

Bachelor's degree in Business, Healthcare Administration, Finance, Analytics

Equivalent years of relevant work experience

Strumenti

Advanced Excel

Claims systems

Data analysis tools

Descrizione del lavoro

CareSource in Ohio is seeking a Claims Reimbursement Analyst II to perform reimbursement analysis that supports accurate claims payment and contract compliance. You will analyze outcomes, identify variances, and assist with configuration, testing, and process improvement activities.

You will collaborate with Claims, Configuration, Provider Contracting, Provider Analytics, and Operations to ensure reimbursement practices align with contracts, fee schedules, and industry standards, while using