Offer summary

Qualifications:

Associates Degree or equivalent work experience required., Minimum of three years in health plan business or systems solutions experience., Advanced proficiency in Microsoft Suite and knowledge of medical terminology is essential., Prior supervisory experience and exposure to Facets or equivalent systems preferred..

Key responsibilities:

Oversee daily activities related to testing of medical benefits and claims workflow.

Guide and train staff, ensuring successful completion of tasks and prioritization of work.

Track issues and provide solutions while maintaining communication with business areas.

Assist in auditing system configurations to ensure accuracy and compliance with standards.

Job description

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:

Responsible for day-to-day activities surrounding the knowledge and insight around testing of medical benefits, provider reimbursement, letters, claims workflow and clinical editing
Guide and direct successful completion of daily tasks. Responsible for onboarding, training and development of staff
Prioritize all work, requests and activities. Escalate any area of significant resource contention along with recommendation for resolution
Track issues and status to ensure proper follow-up, coordination with business area and provide solutions
Update project that configuration is involved with and coordinate any needed changes with manager
Provide management with ticket dashboards. Identify root cause of issues and appropriate pro-active resolution to reduce tickets in the future
Ensure ticket controls, communication and approvals are followed prior to system implementation
Maintain and support fee schedules and methodology is consistent with required standards
Provide oversight to vendor management tasks conducted by team members. Ensure timely responses and resolution
Assist in auditing system configuration to ensure accuracy and internal controls are in place to minimize potential fraud and abuse and any business issues
Perform any other job duties as requested

Education and Experience:

Associates Degree or equivalent years of relevant work experience is required
Minimum of three (3) years of health plan business or systems solutions experience is required
Exposure to Facets or equivalent system is preferred
Prior supervisory experience is preferred

Competencies, Knowledge and Skills:

Advanced computer skills and abilities in Facets or similar processing systems
Medical terminology
Advanced proficiency in Microsoft Suite to include Word, Excel and Access
High level of programming and systems development knowledge
Effective identification of business problems, assessment of proposed solutions to those problems, and understanding of the needs of business partners
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
Knowledge of regulatory reporting and compliance requirements
Excellent listening and critical thinking skills
Effective problem solving skills with attention to detail
Excellent written and verbal communication skills
Ability to work independently and within a team environment
Strong interpersonal skills and high level of professionalism
Ability to develop, prioritize and accomplish goals
Proper medical coding knowledge and claims processing skills

Licensure and Certification:

Certified Professional Coder (CPC) is preferred

Working Conditions:

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

Compensation Range:

$73,260.00 - $117,180.00

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