Provider Network Analyst II (Facets experience a must)

Job Summary:

The Provider Network Analyst II ensures operational effectiveness by assisting in strategic and business planning, including business, financial, and operational goals and objectives.

Essential Functions:

• Provide oversight to all new contracts to ensure that appropriate and timely claims system set up occurs and that rigorous testing yields appropriate outcome prior to payment methodology implementation
• Identify issues related to reimbursement and recommends appropriate solutions.  Includes generating and analyzing queries or reports for analysis
• Analyze provider database to ensure data consistency and optimal database structure
• Takes a leading role in the review of reports and data for pattern identification, special cause variation identification, trend analysis, or other techniques; prepare and deliver summaries, recommendations, or alternatives of the analyzed information
• Serves as provider data representative in claims editing decisions and implementation and oversight of testing to ensure that it yields appropriate claims processing
• Assist in servicing key hospital or other designated providers in all lines of business, existing and future to ensure rapid diagnosis and resolution of complex claims issues
• Build and strengthen provider relationships by facilitating quality service
• Actively participate in operational calls with key providers or network partners as needed
• Proactively communicates technical system changes, claims processing, CareSource policies on reimbursement, take-back initiatives, and configuration
• Ensure all governing body regulations are adhered to at all times for existing and future lines of business
• Mentor internal resources to achieve cross-functional capability with project execution and subject matter expertise
• Perform any other job related duties as requested

Education and Experience:

• Bachelor of Science/Arts degree or equivalent years of relevant work experience is required
• Three (3) years of provider contracts; claims or configuration experience is required
• Five to eight (5-8) years of health care operations experience in insurance, managed care, or related industry is required

Competencies, Knowledge and Skills:

• Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint
• In depth knowledge of Facets
• Knowledge of performance/process improvement methodology highly desired
• Knowledge of provider, customer service and claims functions is required
• Demonstrates excellent analysis and collaboration skills
• Knowledge of claims payment processes
• Strong interpersonal, leadership and relationship building skills
• Ability to effectively interact with all levels of management within the organization and across multiple organizational layers
• Excellent written and verbal communication skills
• Effective listening and critical thinking skills
• Strong interpersonal skills and high level of professionalism
• Effective problem solving skills with attention to detail
• Ability to work independently and within a team environment
• Ability to develop, prioritize and accomplish goals

Licensure and Certification:

• None

Working Conditions:

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

Compensation Range:

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. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business