- Represent claims on cross-functional project work teams
- Submit, monitor and prioritize IT tickets for the Claims department
- Review special projects and identify issue trends and potential resolutions
- Assist with Onbase reporting and processes
- Develop and draft P&P's and job aides for Claims
- Assist in training claims staff on claims processing policy and procedures
- Assist in educating/training Business Partners on claims functions
- Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data.
- Perform analysis of all claims data in order to provide decision support to Claims management team
- Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues
- If assigned to Research and Resolution team, responsibilities include:
- Represent Claims Department at requested provider calls and visits
- Provide feedback and/or face-to-face interaction with providers for claims research and resolution
- Responsible for research and resolution of claims issues for all assigned provider inquiries and submissions
- Responsible for managing provider issues adhering to Workflow processes and tools (Facets and Onbase)
- Provide input for claims business requirements, testing processes and implementation tasks and plans
- Perform any other job related instructions, as requested
- Bachelor's degree or equivalent years of relevant work experience required
- Minimum of two (2) years of healthcare claims environment is required
- Advanced level experience in Microsoft Word, Excel and PowerPoint
- Data analysis and trending skills
- Demonstrated understanding of claims operations specifically related to managed care
- Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
- Ability to work independently and within a team environment
- Attention to detail
- Familiarity of the healthcare field
- Critical listening and thinking skills
- Negotiation skills/experience
- Strong interpersonal skills
- Proper grammar usage
- Technical writing skills
- Time management skills
- Strong communication skills, both written and verbal
- Customer service orientation
- Decision making/problem solving skills
- None
- General office environment; may be required to sit or stand for extended periods of time
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
-
Operations Specialist
2 days ago
Stratacache Dayton, United States_*STRATACACHE*_delivers in-store retail experience transformation and exceptional customer journeys through a wide array of marketing technology. Our solutions enable retailers to learn deeply about their customers' shopping preferences and behaviors, delivering targeted promotio ...
-
Operations Specialist
5 hours ago
STRATACACHE Dayton, United States_*STRATACACHE*_delivers in-store retail experience transformation and exceptional customer journeys through a wide array of marketing technology. Our solutions enable retailers to learn deeply about their customers' shopping preferences and behaviors, delivering targeted promotio ...
-
Store Operations Specialist
4 days ago
At Home Stores LLC Huber Heights, United States Full time$ /hour · The Store Operations Specialist (SOS) leads and trains teams in performing all freight functions, including: unloading, processing, stocking, and resets. · he Store Operations Associate is responsible for unloading, processing, and stocking freight safely and efficientl ...
-
Store Operations Specialist
3 days ago
At Home Stores LLC Dayton, United StatesJob Description$ /hourThe Store Operations Specialist (SOS) leads and trains teams in performing all freight functions, including: unloading, processing, stocking, and Store Operations Associate is responsible for unloading, processing, and stocking freight safely and efficientl ...
-
Network Operations Specialist
1 week ago
STRATACACHE GROUP Dayton, United StatesJob Details · Job Location · STRATACACHE Headquarters - Dayton, OH · Position Type · Full Time · Education Level · High School · Job Category · Information Technology · Description · STRATACACHE delivers in-store retail experience transformation and exceptional customer j ...
-
Operations Specialist II
1 day ago
CareSource Dayton, United StatesJob Summary: · The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects. · Essential Functions: · Represent claims on cross-functional project work teams · Submit, monitor and prioritize IT tickets f ...
-
Cyber Operations Specialist
1 week ago
U.S. Army Dayton, United States Full timeAPPLY HERE: · The Army Virtual Recruiting Team of Columbus Ohio is currently looking to hire Active Duty and Reserve Soldiers.You must enlist in the United States Army to obtain this position. · You must be between the ages of · You must have a GED or High School Diploma. · ...
-
Senior Operations Security Specialist
5 days ago
Armada Dayton, United StatesLocation field must contain 'city, state' or a zip code to perform a radius search (e.g., · Denver, CO · or · City and state must be separated by a comma followed by a space (e.g., · Houston, TX ) · ARMADA Ltd. · Senior Operations Security Specialist · in · Dayton , · Ohi ...
-
Senior Operations Security Specialist
1 week ago
Armada Dayton, United StatesJob Description · Job Description · Type: · Full Time · Location: · Wright Patterson AFB, OH · Overtime Exempt: · No · Reports To: · ARMADA HQ · Security Clearance Required: · Active TS/SCI · Sign on Bonus Available: · Yes, $1K for qualified candidates. · The F-35 Joint ...
-
Temporary Business Operations Specialist
2 days ago
Stratacache Dayton, OH, United States Full time_*STRATACACHE*_delivers in-store retail experience transformation and exceptional customer journeys through a wide array of marketing technology. Our solutions enable retailers to learn deeply about their customers' shopping preferences and behaviors, delivering targeted promotio ...
-
Training for Specialist in Pool Operations
1 week ago
Radiant Innovations Tylersville, United StatesYour training as a specialist for pool operations (m/f/d) at Stadtwerke HalleRequirements · For this training, you need a good academic knowledge and commitment. · Your qualities include customer-oriented and organizational thinking, physical fitness, good general education, and ...
-
Master or specialist for pool operations
1 week ago
Spectrum Innovations Wetherington, United StatesWelcome to the enchanting water worlds of Hanau. The fairytale Heinrich-Fischer-Bad, nestled in the heart of Hanau, as well as the maritime oasis in the greenery - the Lindenau-Bad in the Hanau district of Großauheim - are the perfect places to enjoy swimming and relaxation all y ...
-
Healthcare Claims Operations Specialist II
1 week ago
CareSource Dayton, United StatesJob Summary:The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects.Essential Functions:Represent claims on cross-functional project work teamsSubmit, monitor and prioritize IT tickets for the Claims de ...
-
STRATACACHE GROUP Dayton, United StatesJob DetailsJob LocationSTRATACACHE Headquarters - Dayton, OHPosition TypeFull TimeEducation LevelHigh SchoolJob CategoryInformation TechnologyDescriptionSTRATACACHE delivers in-store retail experience transformation and exceptional customer journeys through a wide array of market ...
-
STRATACACHE GROUP Dayton, United StatesJob DetailsJob LocationSTRATACACHE Headquarters - Dayton, OHPosition TypeFull TimeEducation LevelHigh SchoolJob CategoryInformation TechnologyDescriptionSTRATACACHE delivers in-store retail experience transformation and exceptional customer journeys through a wide array of market ...
-
STRATACACHE GROUP Dayton, United StatesJob Details · Job Location · STRATACACHE Headquarters - Dayton, OH · Position Type · Full Time · Education Level · High School · Job Category · Information Technology · Description · STRATACACHE delivers in-store retail experience transformation and exceptional customer ...
-
STRATACACHE GROUP Dayton, United StatesJob Details · Job Location · STRATACACHE Headquarters - Dayton, OH · Position Type · Full Time · Education Level · High School · Job Category · Information Technology · Description · STRATACACHE delivers in-store retail experience transformation and exceptional customer j ...
-
STRATACACHE Dayton, United States_*STRATACACHE*_ delivers in-store retail experience transformation and exceptional customer journeys through a wide array of marketing technology. Our solutions enable retailers to learn deeply about their customers shopping preferences and behaviors, delivering targeted promotio ...
-
FusionWorks Gratis, United StatesTo expand our team at our location in Bonn, Bornheim, we are currently looking for a Junior Specialist for our Security Operations Center (Blue-Team). · Your Responsibilities · We offer a modern work environment in a young and dynamic team. Our locations have excellent infrastruc ...
-
Es&h Transportation Specialist
3 days ago
Targa Resources Dayton, United States***: · The ES&H Transportation Specialist will be located at the Targa Resources Corporate Office and the Dayton Transportation Terminal in Dayton, TX. · This position will be responsible for managing and ensuring compliance with industry safety regulations and hazardous material ...
Operations Specialist II - Dayton, United States - CareSource
Description
Job Summary:
The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects.
Essential Functions:
Education and Experience:
Competencies, Knowledge and Skills:
Licensure and Certification:
Working Conditions:
Compensation Range:
$60, $96,500.00
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. 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, including disability and veteran status. We are committed to a diverse and inclusive work environment.
