Team Lead, Configuration Testing - Facets / Benefits Configuration Testing is a must

CareSourceDayton, OH, United States

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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 :

Bachelor's 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 :

81,400.00 - $130,200.00 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 : Salary

Competencies :

Create an Inclusive Environment - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

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Configuration Lead • Dayton, OH, United States