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:
$83,000.00 - $132,800.00
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 (hourly/salary):
Salary
Organization Level Competencies
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 environment of belonging that welcomes and supports individuals of all backgrounds.
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