Payment Cycle Analyst III
$72.2k - $115.5kCareSource
Job Summary Payment Cycle Analyst III is responsible for conducting both systemic and targeted analysis to identify reimbursement errors and to determine root cause. As well as collaborating with Configuration, Configuration UAT, Enterprise UAT, IT Claims, and Payment Cycle Team members to ensure test scripts are comprehensive. Essential Functions Provide analytical support and leadership for special projects and initiatives related to reimbursement of claims for both providers and members. Research and provide recommendations to the Reimbursement Committee for reimbursement of services. Research claim results to determine potential errors/discrepancies attributed to clinical edits, claims coding, payment policies, and application of fee schedule and rates. Develop business requirements for payment decisions and manage the implementation process with Configuration, CES, IT and Market stakeholders. Lead special projects to ensure payment discrepancies are resolved and communicated to the appropriate parties. Provide payment expertise at provider meetings, Medicaid Fairs, market workgroups, and any other industry related events. Review and interpret regulatory items and policy manuals to ensure test scenarios support the requirements. Identify test result outputs and Claim SOPs that need to be modified or created to support new or changed business requirements. Build library of re‑usable tests plans & scripts to support the Market. Document the status of test results and gaps in testing for future improvements. Validate Impact Reports to ensure the criteria is consistent with story and universe of claims impacted by the changes. Approve UAT test scripts and test results prior to promoting changes to production and monitor post production results. Validate MCA Tests for expected results and communicate information to Reimbursement Analysts and HP Managers for provider notification. Conduct both systemic and targeted analysis to identify issues with testing and identify process changes for improvement. Create effective written and oral communication materials that summarize findings and support fact based recommendations that can be shared with Configuration, IT, UAT, Reimbursement Committee, Payment Cycle, and Provider Groups. Education and Experience Bachelor's degree required. Equivalent years of relevant work experience may be accepted in lieu of required education. Five (5) years of health plan experience or equivalent experience with health plan operations and configuration required. Experience with user testing required. Experience with payment methodologies and industry pricers (ex: DRG, APC, SNF, RBRVS) preferred. Competencies, Knowledge and Skills Advanced proficiency level experience in Microsoft Suite to include Word, Excel, PowerPoint, Access and Visio. Strong computer skills and abilities in Facets or equivalent claim payment system is preferred. Strong analytical skills with the ability to effectively communicate findings with the Leadership Team. Demonstrated understanding of claims operations, configuration, and testing related to managed care. Understanding of regression, unit, and user acceptance testing is required. Effective listening and critical thinking skills. Effective problem‑solving skills with attention to detail. Creative thinking to develop positive and negative test scenarios. 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, Medicare, and Marketplace. Strong working knowledge of claims processing edits and logic. Familiar with CMS guidelines / HIPAA and Affordable Care Act. Licensure and Certification None required. Working Conditions General office environment; may be required to sit or stand for extended periods of time. Up to 15% (occasional) travel to attend meetings, trainings, and conferences may be required. Compensation Range $72,200.00 - $115,500.00. Equal Opportunity Employer CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #J-18808-Ljbffr CareSource
$83k - $132.8k
Job Summary Payment Cycle Analyst IV is responsible for conducting both systemic and targeted analysis to identify reimbursement errors and to determine... ...multiple initiatives at same time and mentor analysts II and III. Incorporate critical thinking skills and judgment in the...SuggestedHourly payWork experience placementWork at office- ...Business Systems Analyst III Location: Oklahoma City, OK, US, 73120 Req ID: 481001 Welcome to Love's! Our Store & Restaurant Technology... ...data querying tools (preferred) ~ Knowledge of POS systems, payments, and retail or food service technology platforms ~...Suggested
$87.03k - $138.97k
...BUSINESS SYSTEMS ANALYST III - CM WHAT IS THE OPPORTUNITY? Support the Capital Markets Division and Partners to develop, test, implement... ...-sized teams. Understanding of systems development life cycle concepts required. Must be detailed oriented and possess effective...SuggestedWork experience placementRemote work- ...Revenue Integrity Analyst III Join our team as a Revenue Integrity Analyst III at the INTEGRIS... ..., and leadership for complex revenue cycle issues. This position leads high-level... ...corrective actions. Supports escalations of payment policy or denial issues to senior payer...SuggestedFull timeContract workWork at officeShift work
$20.02 - $25.78 per hour
...-F 8:30-5:00 pm EST (or based on business needs) What Revenue Cycle Management (RCM) contributes to Cardinal Health Revenue Cycle... ...frame Calling insurance companies regarding any discrepancy in payment if necessary Reviewing insurance payments for accuracy and...SuggestedHourly payTemporary workWork experience placementLocal areaImmediate startRemote workFlexible hours- Oklahoma Heart Hospital is seeking a Payment Variance Specialist I in Oklahoma City. The role involves resolving payment variances, assisting... ...is required, along with one year of experience in Revenue Cycle. Proficiency in Microsoft Office is essential, and Epic experience...Work at office
$88.8k - $126k
...Type**Regular**Job Description****Summary**The Property and Asset Analyst III manages and maintains all controlled assets accountable to AV,... ...guidance on contracts and regulations pertaining to asset life-cycle management* Determines, recommends, and implements property/...Permanent employmentContract workWork experience placementRemote work- ...process mapping skills Experienced with System Development Life Cycles Strong teaching skills to educate colleagues on new solutions... .... Ability to motivate and guide less experienced Business Analyst Professional Business Analysis designation from an accredited...
- ...Job Title: ISR Analyst III / BIG SAFARI Program Liaison Location: Tinker AFB, OK Minimum Clearance Required: TOP SECRET/SCI security... ...Special Projects, Aeronautical Systems Center/Air Force Life Cycle Logistics Center and associated intelligence organizations and...Contract workTemporary workFor contractorsWork at officeLocal areaImmediate startFlexible hours
$30.55 - $48.12 per hour
...Job Description: The Revenue Cycle Denials Analyst leverages training and experience to track denials across the organization and mitigating root causes that contribute to an increase of denials and a loss of revenue. The caregiver must be able to apply a robust understanding...Hourly payWork at officeRemote work$140k - $185k
Circle is seeking a Lead Analyst, Product Compliance to support their Payments product pillar. The role involves ensuring compliance with regulatory expectations and managing operational risks. Responsibilities include leading risk assessments for payment processes, collaborating...$60.8k - $82.9k
Become a part of our caring community As a Revenue Cycle EDI Systems Analyst , you will report to the VP, RCM. You will be responsible for supporting... ...and company goals. Work with finance to reconcile payments and resolve discrepancies. Support and train staff on system...Bi-weekly payTemporary workApprenticeshipWork at officeRemote workWork from homeHome office$29 - $37 per hour
Cape Cod Healthcare Inc is seeking a Financial Clearance Analyst in Massachusetts for a full-time position with potential for hybrid work... ...will have 3-5 years of experience in a hospital's Revenue Cycle, along with strong data analysis and communication skills. The hiring...Hourly payFull time- The BSA Investigations Analyst III is responsible for the research and investigation of customer and transactional data, as well as reporting to applicable governmental agencies and law enforcement. Investigations involve the collection, analysis, and evaluation of information...Work experience placement
- ...Job Description The Case Analyst II plays a significant role on a fully remote team supporting case analysis and reconciliation of data from the health insurance exchange. As a Case Analyst II, you will be part of a team empowered to collect and reconcile data from...Contract workRemote workFlexible hours
- Security First Bank is seeking an ISO Business Analyst to join their Payment Services Team. This role is responsible for monitoring portfolio activity, performing due diligence, and ensuring the integrity of internal systems. Candidates should have a Bachelor’s degree and...Full timePart timeWork at officeRelocation
$98.09k - $156.95k
...Component - PDBC ~ Product Variable Components - PDVC ~ Service Payment - SEPY ~ Limits - LTLT ~ Deductible - DEDE ~ Benefit... ...Team: Perform key components of the System Development Life Cycle (SDLC): Designing -building solutions that support business needs...Work at officeLocal areaRemote workFlexible hours2 days per week- A reputable insurance firm is looking for an APL Product Actuarial Analyst II/III in Oklahoma City. This role involves performing product development and maintenance activities, as well as providing technical support for regulatory needs. Candidates should have a Bachelor...
- APL Product Actuarial Analyst II/III page is loaded## APL Product Actuarial Analyst II/IIIlocations: Oklahoma City, Oklahomatime type: Full timeposted on: Posted Todayjob requisition id: JR333\*Perform product development and maintenance activities, including experience...Remote work
- ...Documentation Risk Specialist III Job Description Loan documentation and post booking review quality control position reviewing LaserPro and attorney prepared documents. Primarily responsible for analyzing commitments for new, renewed and amended credit transactions...Contract workWork at office
- We are looking for a highly organized, proactive, and articulate Project Analyst to coordinate projects related to the Affordable Care Act. The ideal candidate has an eye for understanding process nuance and policy and will work closely with CMS stakeholders to drive initiatives...Contract workWork experience placement
- Calling all creatives, solvers, analysts, planners, doers, and visionaries!East West Human Machine Interface... ...:The AR/AP specialist manages the company’s full-cycle financials transactions, ensuring accurate vendor payments (AP) and timely customer collections (AR). They...
- ...calculations, value definition, cost assessments (expense/capital), benefits, and risk analyses. Coordinates project tasks and project life cycle phases for small to mid-size projects (i.e. defining requirements, documentation, and process flows, etc.) to meet customer goals...For contractorsLocal areaNight shift
- ...to join our heart-centered team! Responsibilities The OHH Payment Variance Specialist I is responsible for triaging and resolving... .... Experience: One (1) year job related experience in Revenue Cycle required, with emphasis on Cash Posting, Refunds & Credit Balances...Contract workTemporary workReliefWork at officeFlexible hours
$34.55 - $55.19 per hour
...BUSINESS SYSTEMS ANALYST II WHAT IS THE OPPORTUNITY? Serve as the business expert for the development, maintenance, training, regulatory... ...methodologies including quality assurance and business cycle testing. Ability to develop detailed, clearly written business...Hourly payRemote work$89.17k - $142.68k
...Job Description As a Senior Business Systems Analyst - Provider Network Pricing (Medicare Advantage), you will leverage your advanced... ...text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published...Local area$67.8k - $142.2k
...Job Title: SAP Business Systems Analyst Job Category: Information Technology Time Type: Full time Minimum Clearance Required to... ...key processes. SAP Certifications. Participation in a full-cycle implementation or major upgrade. What You Can Expect: A...Full timeContract workWork experience placementFlexible hours$68.4k
...and must also pass a background check. *** The Business Systems Analyst serves as a subject‑matter expert for assigned United Concordia... ...design. Participate in the full software development life cycle by actively participating on Agile scrum teams in various roles,...Contract workFor contractorsWork at officeLocal area$55k - $95k
...forward-thinking team as a full-time System Integration Business Analyst to help drive innovative System Integration projects. If you're... ...Thorough understanding of multiple software development life cycle methodologies and their applications Support business development...Full timeFor contractorsH1bLocal areaRemote workFlexible hours$105k - $130k
...Senior Analyst, Life Sciences Consulting Company: Dedham Group Location: Remote, United... ...: • Accelerate the drug development cycle • Assess competition and bring the right... ...ask for anything of value or any type of payment during or as part of any recruitment,...Full timeTemporary workLocal areaRemote workFlexible hoursShift work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Payment Cycle Analyst III. Be the first to apply!
- document review analyst Oklahoma City, OK
- facility analyst Oklahoma City, OK
- senior strategy analyst Oklahoma City, OK
- disaster recovery analyst Oklahoma City, OK
- consulting analyst Oklahoma City, OK
- contracts analyst Oklahoma City, OK
- compensation analyst Oklahoma City, OK
- due diligence analyst Oklahoma City, OK
- invoice analyst Oklahoma City, OK
- import analyst Oklahoma City, OK

