Operations Specialist II - Facets Dual Processing

@ CareSource

Job Summary

The Operations Specialist II - Facets Dual Processing provides analytical support and leadership for projects impacting Claims and other key internal Claims initiatives at CareSource.

Essential Functions

Key responsibilities include representing Claims on cross-functional project teams, submitting, monitoring, and prioritizing IT tickets, and reviewing special projects to identify trends and resolutions. The role involves assisting in Onbase reporting and process management, developing policies and procedures, and creating training materials for Claims staff and Business Partners. Additionally, the specialist researches and resolves provider claim issues by analyzing system configurations, payment policy, and claims data. You will perform data analysis to support decision-making for Claims management, identify data issues, and contribute to resolution planning. For those on the Research and Resolution team, responsibilities extend to representing the Claims Department on provider calls, offering direct feedback, managing provider issues via Facets and Onbase, and providing input on business requirements and testing processes.

Education and Experience

Bachelor’s degree or equivalent relevant experience is required along with a minimum of two years in a healthcare claims environment. Experience with Facets high dollar claims manual verification and dual product claims processing/adjudication is highly preferred.

Competencies, Knowledge and Skills

• Advanced skills in Microsoft Word, Excel, and PowerPoint
• Strong data analysis and trending abilities
• Understanding of managed care claims operations
• Proficiency in coding and billing processes (CPT, ICD-9, ICD-10, HCPCS)
• Ability to work both independently and in a team
• Attention to detail and strong technical writing skills
• Effective communication and customer service orientation

Working Conditions and Compensation

This role is primarily office based, though it is designated as 'REMOTE'. It includes a comprehensive total rewards package, potential bonus based on performance, and salary ranging based on candidate experience.

Key skills/competency

• Claims
• Analysis
• Facets
• Onbase
• Training
• Reporting
• Data
• Resolution
• Compliance
• Communication