Claims Systems Analyst

Company Name:
CareCore National
Job Description:
_ About CareCore National
Come ride the wave of healthcare change! CareCore National is a fast growing company addressing the issues of rising healthcare costs. CareCore National provides physicians with access to the latest evidence-based criteria and works collaboratively with providers to improve the way care is delivered to patients. We focus on appropriateness to ensure that health plan members receive the right procedure for their clinical situation. We achieve this by employing state-of-the-art technology and evidence-based criteria. All CareCore National programs improve quality, streamline patient care and reduce cost._
Our corporate office is located in beautiful Bluffton, SC conveniently located near Hilton Head Island, SC; Savannah, GA; and Beaufort, SC. The "Low Country" offers ocean front beaches, alluring rivers and small town southern charm.
_Position Overview_
CareCore National''s Claims team is looking for someone who will handle all related aspects of the new business and initiatives on claims systems processes and claims business rules. Includes claims systems utilization, reporting, claims related business and systems analyses. The ideal candidate will be responsible for:
Designing and documenting best practice of incorporating new business and/or requirements
Documenting load requirements for claims, membership, providers, sites, vendors, pricing, etc
Configuring new business and/or requirements for claims, membership, providers, sites, vendors, pricing, etc
Collaborating on testing and trouble-shooting new and existing configurations with the Quality Assurance Analyst
, External Job Requirements:
The ideal candidate will need to meet the following requirements:
Bachelor''s Degree in a computer related field preferred or equivalent work experience
3+ years experience in
Claims editing
ICD-9, CPT Coding
Claims adjudication and payment
Manual intervention with claims systems
Proficient in Microsoft Excel (including pivot tables, charts and formulas)
Knowledge of the claims lifecycle
Strong communication (written and oral) skills and interpersonal skills
Familiarity with software applications (MS Access), database management systems (DB2, SQL Server) and other business related technologies preferred
This position may work remotely
Requisition Number: 469
City: Bluffton
State: South Carolina
Job Title: Claims Systems Analyst
Area of Interest: Claims

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