Excellent employment opportunity!
About Us:
CareMore is looking for a dynamic individual to join our team!
CareMore is a leading healthcare system specializing in providing a complete, pro-active health care experience to Senior Americans. CareMore strongly believes in our innovative and caring vision to lead the next generation of health care and we look for candidates that share in our passion.
As a leader in senior healthcare for over 20 years, our vision is to significantly improve the lives of Medicare recipients throughout California by employing a dedicated staff of professionals who are passionate about changing lives. When you join CareMore, we’ll give you every opportunity to make a real difference.
Be More with CareMore.
TERMS AND CONDITIONS ANALYST
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Job Description:
It is the responsibility of the Terms and Conditions System Analyst to assist as needed in ensuring that set up and maintenance related to capitation and/or pricing are completed timely and accurately. System Analyst will work closely with both the Capitation Analyst and Lead System Analyst on any project. *Temporary Position*
Responsibilities Include:
- Track It Ticket assign daily as requests are made
- Basic Understanding of Capitation, including but not limited to per member per month, capitation rates and retroactivity.
- Primary Care Physician Capitation processing
- Specialty Cap Physician Capitation processing
- Ability to analyze capitation processing results
- Capitation Rate Maintenance
- Service Definition Maintenance
- Basic understanding of all Medicare Payment methodologies for provider types.
- Pricing Files Maintenance
- Knowledgeable with any new State and Federal rules and regulations related to insurance and government agencies billing, by reading articles and attending meeting and seminars
- Responsible for reading and complying with any and all CareMore Policy and Procedures
- Conform with the confidentially of CareMore and its patients and employees
- Attends all of the department meetings and in-services requested by immediate supervisor and top management
- Keeps work area neat and organized to convey a professional appearance to coworkers and visitors.
- All other duties assigned by Management
Education and Experience:
- Minimum five years in Managed Health Care.
- Knowledge of PMPM
- Proficient in EZ-Cap and Facets with basic understanding of the capitation module
- Knowledge of Medicare, Medi-Cal and CMS guidelines.
- Written and verbal communications a must.
- Full understanding of Human Resources rules and guidelines.
- Ability to multi-task and time management skills.
- Proficient in MS Excel, Word, and other software systems.
- General understanding of Access, SQL, Crystal, and Hyperion Reporting Software
Compensation/Benefits:
CareMore offers a comprehensive benefits package to include medical, dental, vision, life, long term disability, flexible spending accounts, 401(k), PTO, and much more.
AA/EOE M/F/D/V
Watch how our CareMore Employees care more, in the video below.
