Configuration Analyst III - SDET, Automation Experience

February 18

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CareSource

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CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

Medicaid • MyCare Ohio • Health Insurance Marketplace • Medicare Advantage • Health Insurance

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

📋 Description

• The Configuration Systems Analyst III is responsible for managing and defining system configuration requirements. • Manage and define system configuration requirements. • Responsibility for requirements, definition, document, design, testing, training and implementation support using appropriate templates or analysis tool. • Develop and utilize reports to analyze and stratify data in order to address gaps and provide answers to issues identified within the department or by other departments. • Identify, manage and document the status of open issues, configuration design, and final resolution within change management system. • Review and interpret regulatory items, timely delivery of required updates. • Development of standard code set and reimbursement design templates. • Plan and implement new software releases including testing and training. • Participate in meetings with business owners, users and IT to achieve solutions that meet the requirements and expectation of CareSource. • Lead configuration initiatives in payment policy meetings and present to committees. • Coordinate annual benefit changes with internal resources. • Provide analysis of efficiencies related to system enhancement and automation. • Review, analyze, and document effectiveness and efficiency of existing systems and develop strategies for improving or further leveraging systems. • Manage the reimbursement review. • Identify and design appropriate changes. • Lead the development and execution of test plans and scenarios for all reimbursement designs for core business system and related processes. • Audit configuration to ensure accuracy and internal controls to minimize fraud and abuse and overpayment related issues. • Anticipate and identify customer needs and match products and services to facilitate the fulfillment of those needs. • Ensure system processes and documents exist as basis for system logic. • Manage resources and communications to facilitate work completion. • Mentor the use of tools to define requirements. • Perform any other job duties as requested.

🎯 Requirements

• High School Diploma or GED is required • Bachelor’s degree or equivalent years of relevant work experience is preferred • A minimum of five (5) years of health plan experience, to include three (3) years of configuration or clinical editing software experience is required • Exposure to Facets or equivalent system is preferred • Exceptional computer skills and abilities in Facets • Advanced proficiency Microsoft Suite to include Word, Excel, Access and Visio • Proven understanding of database relationships required • Understanding of DRG and APC reimbursement methods • Understanding of CPT, HCPCs and ICD-CM Codes • Knowledge of HIPAA Transaction Codes • Effective 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 • Understanding of the healthcare field and knowledge of Medicaid and Medicare • Proper medical coding knowledge and claims processing skills • Customer service oriented • Facets knowledge/training • Ability to manage vendor relationships