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Application Developer III

CareSource Management Services LLC
Dayton, OH
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84253437 291783652 Job Summary: The Application Developer III is responsible ...
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for the designing, coding, testing, and analyzing software programs and applications including research, design, documenting and modifying throughout the production lifecycle. Essential Functions: Analyze, Design, code and test software through the production lifecycle according to functional/technical specifications that meet business requirements Run and monitor software performance tests on new and existing software for the purposes of correcting errors, isolating areas for improvement, and general debugging...
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5
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Actuarial Analyst II (Medicaid)

CareSource Management Services LLC
Dayton, OH
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84253439 291783756 Job Summary: The Actuarial Analyst II is responsible for ...
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providing timely, accurate, and actionable data, analysis and recommendations supporting the department, area, and corporate key initiatives. Essential Functions: Develops actionable recommendations to management relative to all analysis Calculates profitability reports on appropriate business segments Leads regular and ad-hoc analysis identifying opportunities to improve efficiency and affordability Leads regular and ad-hoc analysis/studies to evaluate assumptions used in other processes Participates in cross...
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6
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6
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Data Engineer III

CareSource Management Services LLC
Dayton, OH
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84253440 291783758 Job Summary: The Data Engineer III is responsible for ...
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engineering, architecting, developing, and implementing unique and innovative enterprise wide, graphics-based, business intelligence solutions that deliver actionable information to the business with a high degree of impact. Essential Functions: Key contributor for data stewardship workgroups and teams in data management and governance activities Be a champion or ambassador of metadata and data quality practices across the organization - leading lunch 'n' learn sessions, knowledge sharing sessions, etc. Gain an...
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Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
7
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Operational Excellence Analyst I (Hybrid)

CareSource Management Services LLC
Dayton, OH
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84249656 291759799 Job Summary: The Operational Excellence Analyst I is ...
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responsible for oversight and monitoring of Operations regulatory and accreditation requirements as well as specific HEDIS initiatives. This hybrid position works Wed & Thurs in office every week at the Dayton OH HQ location. Essential Functions: Oversight and monitoring of Operations regulatory requirements Oversight and monitoring of Operations specific HEDIS initiatives and accreditation requirements Identify and perform oversight and monitoring of Claims, Provider Appeals, Provider Services (claims processing only),...
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Applied Math
5
Graphic Literacy
5
Workplace Documents
5
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Medical Records Coordinator II

CareSource Management Services LLC
Dayton, OH
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84249659 291759818 Job Summary: The Medical Records Coordinator II is ...
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responsible for all forms and aspects of retrospective medical record retrieval including, but not limited to, claims data analysis, outreach data research, direct EMR retrieval, Requests of Information (ROI) deployment, pend-record resolution, medical record audits, attestation capture, and report documentation. This position is hybrid and will report to the Dayton, OH office twice a week. Essential Functions: Execute the request, retrieval, and pend resolution of medical records through various channels Utilize custom and...
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4
Graphic Literacy
4
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Risk Adjustment Coding Auditor II (AAPC or AHIMA coding certification required)

CareSource Management Services LLC
Dayton, OH
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84239101 291752578 Job Summary: The Risk Adjustment Coding Auditor II is ...
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responsible for performing over-reads of vendor ICD-10 coding, reviewing provider documentation supplied to them, and diagnostic codes assigned by vendor. Essential Functions: Meets assigned volume metrics Validates the accurateness of ICD-10 codes assigned by the vendor Tracks the trends and reports on the findings Demonstrates a thorough understanding of Risk Adjustment hierarchical condition categories (HCCs), for all risk adjusted products Participates in quality coding initiatives as appropriate or assigned...
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Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
6
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Enrollment Specialist II

CareSource Management Services LLC
Dayton, OH
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84239098 291752548 Job Summary: The Enrollment Specialist II is responsible ...
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for reviewing files and interpreting data to enter members into eligibility systems according to appropriate regulatory guidelines. Essential Functions: Process work items according to appropriate regulatory guidelines Review files and interpret the data to enter members into eligibility systems Completion of daily change file pre-processor exceptions and monthly full file pre-processor exceptions Research member eligibility and take appropriate actions to resolve issues across all eligibility systems Process mass...
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Applied Math
4
Graphic Literacy
4
Workplace Documents
4
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Manager, Compliance

CareSource Management Services LLC
Dayton, OH
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84239100 291752557 Job Summary: The Manager, Compliance is responsible for ...
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supporting the establishment of a baseline compliance risk, identification of areas of potential exposure, development and alignment of compliance risk management strategies with CareSource goals and objectives, and execution of the compliance program ensuring consistency. Essential Functions: Partner with Business Units and internal support functions to help ensure that all compliance requirements have been met; risk is monitored and remediated through testing/ development/ implementation and use Remain current in...
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From:
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Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
apply
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Medical Director Appeals Medical Director - Pacific Standard Time, Managed Care

CareSource Management Services LLC
Dayton, OH
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84239099 291752550 Job Summary: The Medical Director is responsible for ...
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supporting staff by providing training, clinical consultation, and clinical case review for members. Essential Functions: Provide prior authorization medical reviews, consultation and clinical review services Participate in peer-to-peer discussions Provide provider education, training, data sharing, performance evaluations and orientation to the plan Conduct clinical reviews for designated CareSource members as requested Provide physician review for clinical appeals cases Participate in the evaluation and investigations...
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From:
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Certifications / Licenses:
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
apply
Detailed Job Information

Mom and Baby Care Manager

CareSource Management Services LLC
Dayton, OH
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84239102 291752581 Job Summary: The Care Manager collaborates with members ...
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of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population with culturally competent delivery of care, services and supports. Facilitates communication, coordinates care and service of the member through assessments, identification, person-centered planning, assist the member in creation and evaluation of person-centered care plans to prioritize and address what matters most, behavioral,...
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From:
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Certifications / Licenses:
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
apply
Detailed Job Information
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