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 required
• Benefit configuration or coding experience required
• Minimum of three (3) years audit experience is required
• Managed Care or Healthcare experience is required

Competencies, Knowledge, and Skills:

• Advanced proficiency with Microsoft Suite to include Excel, Word, Visio, and PowerPoint
• Comprehensive understanding of Benefits Requirements
• Understanding of CPT, HCPCS and diagnosis codes
• Excellent problem resolution skills with attention to detail
• Strong interpersonal skills and high level of professionalism
• Critical listening and thinking skills
• Ability to work independently and within a team environment
• Proven ability to juggle multiple, complex priorities within a changing environment
• Excellent written and verbal communication skills
• Time management and the ability to develop, prioritize and accomplish goals

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Ability to travel as required by the needs of the business

Compensation Range:

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):

Organization Level 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.