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in Dayton, OH
Operations Specialist II
Estimated Pay | $18 per hour |
---|---|
Hours | Full-time, Part-time |
Location | Dayton, Ohio |
Compare Pay
Estimated Pay$13.1
$17.91
$25.56
About this job
Job Summary:
The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects.
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
Education and Experience:
- Bachelor's degree or equivalent years of relevant work experience required
- Minimum of two (2) years of healthcare claims environment is required
Competencies, Knowledge and Skills:
- 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
Licensure and Certification:
- None
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$60,300.00 - $96,500.00 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. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies: