Team Lead Configuration Testing - Pricing/Networx/Facets

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:

• Associates 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:

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