Payment Policy & Claims Analytics Analyst II

Remote Co.; Dayton (OH); On-site; USD 63,000 - 100,000; Full time

Job summary

CareSource is seeking a Payment Cycle Analyst II in Dayton, OH to provide analytical leadership for Claims-related projects. The role defines policy requirements for clinical edits, researches reimbursement policies, analyzes claims for errors, and supports UAT plus post-implementation validation.

Strong communication and data analysis skills are essential in a team-focused environment. The position requires a Bachelor’s degree and at least three years in health plan settings; experience with

Qualifications

• Bachelor’s degree or equivalent years of relevant work experience.
• Minimum of three (3) years of health plan experience.
• Experience with clinical editing software preferred.

Responsibilities

• Define policy requirements to support configuration of clinical editing system.
• Research reimbursement policy edits and assess network impact.
• Analyze claim results to identify errors and root causes.
• Support UAT and validate implementation results.
• Prepare written and oral materials for providers and managers.

Skills

Clinical edits

Data analysis

Communication

HIPAA knowledge

Education

Bachelor’s degree

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

Microsoft Visio

Facets

CPT/ICD codes

Job description

CareSource is seeking a Payment Cycle Analyst II in Dayton, OH to provide analytical leadership for Claims-related projects. The role defines policy requirements for clinical edits, researches reimbursement policies, analyzes claims for errors, and supports UAT plus post-implementation validation.

Strong communication and data analysis skills are essential in a team-focused environment. The position requires a Bachelor’s degree and at least three years in health plan settings; experience with