Job Summary:
The Team Lead, Configuration Testing is responsible for day-to-day activities surrounding the knowledge and insight around testing of medical benefits, provider reimbursement, letters, claims workflow and clinical editing.
Essential Functions:
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Responsible for day-to-day activities surrounding the knowledge and insight around testing of medical benefits, provider reimbursement, letters, claims workflow and clinical editing
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Guide and direct successful completion of daily tasks. Responsible for onboarding, training and development of staff
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Prioritize all work, requests and activities. Escalate any area of significant resource contention along with recommendation for resolution
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Track issues and status to ensure proper follow-up, coordination with business area and provide solutions
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Update project that configuration is involved with and coordinate any needed changes with manager
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Provide management with ticket dashboards. Identify root cause of issues and appropriate pro-active resolution to reduce tickets in the future
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Ensure ticket controls, communication and approvals are followed prior to system implementation
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Maintain and support fee schedules and methodology is consistent with required standards
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Provide oversight to vendor management tasks conducted by team members. Ensure timely responses and resolution
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Assist in auditing system configuration to ensure accuracy and internal controls are in place to minimize potential fraud and abuse and any business issues
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Perform any other job duties as requested
Education and Experience:
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Bachelor's Degree or equivalent years of relevant work experience is required
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Minimum of three (3) years of health plan business or systems solutions experience is required
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Exposure to Facets or equivalent system is preferred
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Prior supervisory experience is preferred
Competencies, Knowledge and Skills:
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Advanced computer skills and abilities in Facets or similar processing systems
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Medical terminology
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Advanced proficiency in Microsoft Suite to include Word, Excel and Access
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High level of programming and systems development knowledge
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Effective identification of business problems, assessment of proposed solutions to those problems, and understanding of the needs of business partners
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Demonstrated ability to successfully define a portfolio of initiatives including business requirements gathering, definition/prioritization, project scope definition, project staffing requirements, application configuration, testing approach, training, documentation, reporting strategy, and change management process
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Knowledge of regulatory reporting and compliance requirements
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Excellent listening and critical thinking skills
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Effective problem solving skills with attention to detail
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Excellent written and verbal communication skills
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Ability to work independently and within a team environment
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Strong interpersonal skills and high level of professionalism
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Ability to develop, prioritize and accomplish goals
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Proper medical coding knowledge and claims processing skills
Licensure and Certification:
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Certified Professional Coder (CPC) is preferred
Working Conditions:
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General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$83,000.00 - $132,800.00
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):
Salary
Organization Level Competencies
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