Job Summary :
The Benefits Coding & Support Quality and Process Improvement Analyst III performs all auditing functions for the Coding Analysts and Benefit Support Analyst. This role implements and executes processes that support the day-to-day activities of Benefits Coding & Support for all markets and products.
Essential Functions :
- Develop and maintain an audit program to support the BC&S quality requirements
- Perform both regular and targeted quality audits of BC&S work and provide audit results with feedback by utilizing all requirement inputs used by the BC&S team.
- Generate comprehensive, clear, concise, and in-depth reporting and analysis and provide recommendations based on audit findings
- Create, maintain, and / or provide feedback and assistance in the review of SOP's and provide constructive feedback
- Assist in the development and maintenance of the cross-functional process flows
- Develop and utilize reports to analyze and stratify data to provide answers to benefit issues identified within the department or by other departments
- Collaborate with BC&S leadership on establishing appropriate performance metrics and visualizing operational data
- Lead continuous improvement initiatives throughout the team focused on quantitative results
- Assist in the Onboarding process
- Assist in training and development of new hires and continuous training for peers
- Facilitate meetings and collaboration
- Act as a change agent / coach to instill and sustain changes
- Perform any other job duties as requested
Education and Experience :
Bachelor's degree in a related field or equivalent years of relevant work experience is requiredBenefit configuration or coding experience requiredMinimum of three (3) years audit experience is requiredManaged Care or Healthcare experience is requiredCompetencies, Knowledge, and Skills :
Advanced proficiency with Microsoft Suite to include Excel, Word, Visio, and PowerPointComprehensive understanding of Benefits RequirementsUnderstanding of CPT, HCPCS and diagnosis codesExcellent problem resolution skills with attention to detailStrong interpersonal skills and high level of professionalismCritical listening and thinking skillsAbility to work independently and within a team environmentProven ability to juggle multiple, complex priorities within a changing environmentExcellent written and verbal communication skillsTime management and the ability to develop, prioritize and accomplish goalsLicensure and Certification :
NoneWorking Conditions :
General office environment; may be required to sit or stand for extended periods of timeAbility to travel as required by the needs of the businessCompensation Range :
$70,800.00 - $113,200.00 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 EnvironmentCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand the BusinessThis 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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