3 Operations Specialist II - R7300 Jobs in Dayton, OH
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Operations Specialist II - R7300
$63k-79k (estimate)
Full Time | Wholesale
4 Days Ago
CareSource is Hiring an Operations Specialist II - R7300 Near Dayton, OH
Job SummaryThe Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects.
Essential Functions
Compensation TypeSalary
Competencies
Essential Functions
- Represent claims on cross-functional project work teams
- Submit, monitor and prioritize IT tickets for the Claims department
- Review special projects and identify issue trends and potential resolutions
- Assist with Onbase reporting and processes
- Develop and draft P&P’s and job aides for Claims
- Assist in training claims staff on claims processing policy and procedures
- Assist in educating/training Business Partners on claims functions
- Research 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 team
- Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues
- If assigned to Research and Resolution team, responsibilities include:
- Represent Claims Department at requested provider calls and visits
- Provide feedback and/or face-to-face interaction with providers for claims research and resolution
- Responsible for research and resolution of claims issues for all assigned provider inquiries and submissions
- Responsible 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 plans
- Perform any other job related instructions, as requested
- Bachelor’s degree or equivalent years of relevant work experience required
- Minimum of two (2) years of healthcare claims environment is required
- Advanced level experience in Microsoft Word, Excel and PowerPoint
- Data analysis and trending skills
- Demonstrated understanding of claims operations specifically related to managed care
- Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
- Ability to work independently and within a team environment
- Attention to detail
- Familiarity of the healthcare field
- Critical listening and thinking skills
- Negotiation skills/experience
- Strong interpersonal skills
- Proper grammar usage
- Technical writing skills
- Time management skills
- Strong communication skills, both written and verbal
- Customer service orientation
- Decision making/problem solving skills
- None
- General office environment; may be required to sit or stand for extended periods of time
Compensation TypeSalary
Competencies
- Create an Inclusive Environment - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
Job Summary
JOB TYPE
Full Time
INDUSTRY
Wholesale
SALARY
$63k-79k (estimate)
POST DATE
06/24/2024
EXPIRATION DATE
08/18/2024
WEBSITE
caresourceok.com
HEADQUARTERS
OKLAHOMA CITY, OK
SIZE
25 - 50
FOUNDED
1996
CEO
LARRY PIERCE
REVENUE
$5M - $10M
INDUSTRY
Wholesale
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