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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Assist with the identification and implementation of solutions with result in efficient, accurate, and quality configuration and maintenance of Facets. Review requirements documents and validate discrepancies or missing information. Consult with assigned operational areas to support business requirements, goals and metrics. Ensure timely configuration and implementation of selected solutions either by directly completing the solution or providing specifications and/or instructions for completion of the solution. Accountable for complying with all laws and regulations that are associated with assigned duties and responsibilities.
- Configure Facets provider agreements in NetworX, load fee schedules, manage capitation.
- Design new configuration to support business needs and functionality.
- Accurately update, implement and test configuration changes.
- Accurately document changes and communicate changes with the business.
- Analyze business requirements, test plans, training materials and procedure documents.
- Execute test plans and test case scenarios to ensure requirements are being met.
- Troubleshoot claims and HelpDesk issues related to pricing.
- Create and maintain configuration related to provider data.
- Participate in development of detail design and system walk through with respective teams to verify design & solution meet business and system requirements.
- Assist and work with business areas for the review of all reported system defects.
- Monitor, research, and resolve help tickets.
- Responsible for quality assurance tasks.
- Document the configuration of new agreement configuration as well as changes to existing agreements.
- Define, develop and document business requirements to ensure needs are captured and delivered.
- Develop an understanding of Facets Batch Logs, with the ability to troubleshoot issues.
- Interact with business leaders and users, including external partners and customers as required.
- Maintain professional, service oriented relationships.
- Judge severity of problems and the need to escalate to management or employ external services.
- Demonstrate ability to organize and prioritize work.
- Participate in special projects and committees as assigned.
- Meet department and company performance and attendance expectations.
- Perform other duties as assigned.
Education, Certificates, Licenses:
- Minimum two years of relevant experience in health plan environments required.
- Minimum one year of general Facets experience required.
- Minimum 1 year experience working with benefit administration required.
- Proficient level work in Excel and Word.
- Access and/or SQL experience preferred.
- Must have knowledge of CPT, ICD-10, HCPCs and Revenue Codes.
- Strong analytical skills and problem solving skills.
- Excellent communication skills both verbal and written.
- Ability to participate in a team environment.
- Self-starter who requires minimal supervision.
BS/BA or equivalent combination of work experience and educationKnowledge:
Extensive knowledge of industry standards and internal PacificSource, PacificSource Medicare, and/or PacificSource Administrators benefits, policy and processes. Competencies
- Building Customer Loyalty
- Building Strategic Work Relationships
- Building Trust
- Continuous Improvement
- Contributing to Team Success
- Planning and Organizing
- Work Standards
Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.Our Values
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
- We encourage creativity, innovation, and the pursuit of excellence.
Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.Disclaimer:
This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.