Senior Claims Policy & Payment Analytics Analyst

CareSource; Georgia; Hybrid; USD 63,000 - 100,000; Full time

Job summary

CareSource is seeking a Payment Cycle Analyst II in Georgia to provide analytical support and leadership for Claims-related projects, including policy and system configurations. This role emphasizes policy development, data-driven analysis, and cross-functional collaboration with providers and health plan teams.

The position requires a Bachelor’s degree and at least three years of health plan experience, with responsibilities spanning policy evaluation, system edits, and stakeholder

Qualifications

• Bachelor’s degree or equivalent years of relevant work experience required.
• Minimum of three (3) years of health plan experience or equivalent with provider coding and claim payment policies.
• Experience working with clinical editing software preferred.
• Certified Medical Coder preferred (licensure)

Responsibilities

• Define clinical and payment policy requirements to support configuration of clinical editing system.
• Conduct and research potential new reimbursement policy claim edits and analyze data.
• Identify reimbursement errors and determine root cause and impact.
• Prepare documentation and obtain approval prior to implementation.
• Provide input to UAT and validate post-implementation results.
• Communicate findings and recommendations to providers and Health Partner Managers.

Skills

Data analysis

Claims processing knowledge

CPT/HCPCS/ICD-CM

Microsoft Word

Microsoft Excel

Education

Bachelor's degree or equivalent

Tools

Facets

Job description

CareSource is seeking a Payment Cycle Analyst II in Georgia to provide analytical support and leadership for Claims-related projects, including policy and system configurations. This role emphasizes policy development, data-driven analysis, and cross-functional collaboration with providers and health plan teams.

The position requires a Bachelor’s degree and at least three years of health plan experience, with responsibilities spanning policy evaluation, system edits, and stakeholder